Megadolicho basilar artery as a cause of asymmetrical sensorineural hearing loss - case report

Summary

Introduction: At the differentiated diagnosis of asymmetrical sensorineural hearing losses, vascular disorders are present, one of which is megadolicho basilar artery. This disease is generally asymptomatic, and when symptoms are found, they can be caused by a compression or ischemia. Clinically, sensorineural hearing loss, tinnitus, headache, facial hypoesthesia, trigeminal neuralgia, vertigo, diplopia and facial palsy, among others, are likely to occur. The image examination of choice for its diagnosis is nuclear magnetic resonance. The megadolicho basilar artery therapy can be surgical or conservative, according to the associated findings. A multidisciplinary approach, including a neurologist, neurosurgeon and an otorhinolaryngologist is recommended for a proper administration of the case.

Objective: Report the case of a patient with asymmetrical sensorineural hearing loss, diagnosed of megadolicho basilar artery.

Case report: JBS, 57-year-old white male with a history of asymmetrical sensorineural hearing loss and bilateral whistle-like tinnitus for several years. The otorhinolaryngologic evaluation, including otoscopy, anterior rhinoscopy and oral pharynx, was normal.

Final Comments: The treatment consisted in following up with the patient, controlling the tinnitus by drugs and using an individual sound amplification apparatus on the left ear.

Resumo

Introdução: No diagnóstico diferencial das perdas sensorioneurais assimétricas fazem parte os distúrbios vasculares e dentre essas alterações encontra-se o dolicomega da artéria vértebro-basilar. Habitualmente essa doença é assintomática e quando há sintomas esses podem ser causados por compressão ou isquemia. Clinicamente podem ocorrer: perda neurossensorial, zumbido, cefaleia, hipoestesia facial, neuralgia trigeminal, vertigem, diplopia e paralisia facial entre outros. O exame de imagem de escolha para seu diagnóstico é a ressonância nuclear magnética. A terapia do dolicomega da artéria basilar pode ser intervencionista ou conservadora dependendo dos achados associados. A abordagem multidisciplinar incluindo neurologista, neurocirurgião e otorrinolaringologista para adequada condução do caso é recomendada.

Objetivo: Relatar o caso de um paciente com perda auditiva neurossensorial assimétrica cujo diagnóstico foi de dolicomega da artéria basilar.

Relato do Caso: JBS, 57 anos, sexo masculino, branco com história de hipoacusia neurossensorial assimétrica e zumbido tipo apito bilateral há vários anos. Exame otorrinolaringológico apresentando otoscopia, rinoscopia anterior e orofaringe normais.

Comentários Finais: O tratamento consistiu de acompanhamento do paciente, controle do zumbido com medicação e uso de um aparelho de amplificação sonora individual na orelha esquerda.

Keywords

basilar artery - tinnitus - sensorineural hearing loss

Palavras-chave

artéria basilar - zumbido - perda auditiva neurossensorial

• References

• 1 Benecke Jr JE, Hitselberger WE. Vertigo caused by basilar artery compression of the VIII nerve. Laryngoscope 1988; 98: 807-9
• 2 Shin JH, Byun BJ, Kim DW, Choi DL. Neurenteric cyst in the cerebellopontine angle with xanthogranulomatous changes: serial MR findings with pathologic correlation. Am J Neuroradiol 2002; 23: 663-5
• 3 Lemaire MC, Beutter P. Brainstem Auditory Evoked Responses in Patientes with Tinnitus. Audiology 1995; 34: 287-300
• 4 Otterstedde CR, Tischendorf M, Reisser C. Megadolichobasilar artery as the etiology of sensorineural deafness in differential sudden deafness diagnosis] HNO. 1999; 47: 494-6
• 5 Lopez-Dominguez JM, Casado-Chocan JL, Blanco-Ollero A, Rodriguez-Verdugo M, Robledo-Strauss A, Diaz-Espejo C. Bilateral hypoacusia and basilar dolichoectasia. Rev Neurol 1996; 24 (136) 1538-40
• 6 Cavallari FEM, Feres MCLC, Isac ML, Oliveira JAA. Tinnitus in a patient with dolichomegabasilar: a case report. Rev Bras Otorrinolaringol 2004; 70 (2) 250-253
• 7 Guiral H, Risco J, Ferrer F. Otoneurological manifestations of basilar dolicoectasia - a report of six cases: Acta Otorrinolaringol Esp. 1997; 48 (5) 337-40
• 8 Jacobson DM, Corbett JJ. Downbeat nystagmus and dolichoectasia of the vertebrobasilar artery. J Neuroophthalmol 2002; 22 (2) 150-1
• 9 Buttner U, Ott M, Helmchen C, Yousry T. Bilateral loss of eighth nerve function as the only clinical sign of vertebrobasilar dolichoectasia. J Vestib Res 1995; 5 (1) 47-51
• 10 Welsh LW, Welsh JJ, Lewin B. Basilar artery and vertigo. Ann Otol Rhinol Laryngol 2000; 109 (7) 615-22
• 11 Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S. High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. Am J Neuroradiol 1986; 7 (1) 61-72
• 12 Nishizaki T, Tamaki N, Takeda N, Shirakuni T, Kondoh T, Matsumoto S. Dolichoectatic basilar artery: a review of 23 cases. Stroke 1986; 17: 1277-81
• 13 Liu CH, Lin SK, Chang YJ. Cochlear vertebral entrapment syndrome: a case report. Eur J Radiol 2001; 40 (2) 147-50
• 14 Campos CR, Doria-Netto HL, Souza-Filho AM, Silva Júnior HM. Dolicoectasia gigante e oligossintomática da artéria basilar descoberta após uma isquemia: relato de caso. Arq Neuro-Psiquiatr 2007; 65 (2A): 345-7
• 15 Meyerhoff WL, Mickey BE. Vascular decompression of the cochlear nerve. Laryngoscope 1988; 98 (6) 602-4