PMC5940739_01
MRIs of the patients. Patients showed single or multiple acute infarctions in the cerebral hemispheres (arrows) or cerebellum concurrent with acute audiovestibulopathy.
fneur-09-00311-g001.jpg
PMC5940739_02_fneur-09-00311-g001.jpg
F1
Brain MRIs disclosed a tiny acute infarction in the tail portion of left hippocampus (Figure 1, 3).
Combined audiovestibulopathy due to cardiac septic embolism. This 42-year-old woman (patient 1) with right audiovestibulopathy from cardiac septic embolism shows tender maculopapular rashes in both feet (A), multiple scattered retinal hemorrhages with a white center (Roth spots, arrow heads) in both eyes (B), left beating nystagmus after horizontal head-shaking [(C), H = horizontal position of the left eye, V = vertical position of the left eye, T = torsional position of the left eye. In each recording, upward deflection indicates rightward, upward, and clockwise eye motion.] Patient 1 showed right caloric paresis of 81% [(D), SPV = slow phase velocity], complete hearing loss in the right ear (E), and gadolinium enhancements of the vestibule, cochlea, and semicircular canals [insets, (F)].
fneur-09-00311-g002.jpg
PMC5940739_01_fneur-09-00311-g002.jpg
F2
Figure 2A). Fundus examination disclosed multiple scattered retinal hemorrhages with a white center (Roth spots) in both eyes (Figure 2B). Examination showed no SN nystagmus either with or without visual fixation, but horizontal head-shaking induced left beating nystagmus (Figure 2C). Bithermal caloric tests showed right canal paresis of 81% (Figure 2D). Pure-tone audiometry documented right hearing loss (Figure 2E). Brain MRIs disclosed gadolinium enhancements of the vestibule, cochlea, and semicircular canals on the right side (Figure 2F) as well as multiple scattered infarctions in the frontal and occipital lobes (Figure 1, 1).
PMC5940739_02
MRIs of the patients. Patients showed single or multiple acute infarctions in the cerebral hemispheres (arrows) or cerebellum concurrent with acute audiovestibulopathy.
fneur-09-00311-g001.jpg
PMC5940739_02_fneur-09-00311-g001.jpg
F1
Brain MRIs disclosed a tiny acute infarction in the tail portion of left hippocampus (Figure 1, 3).
Isolated vestibulopathy in patient 3 with patent foramen ovale. (A) Video-oculography shows spontaneous nystagmus beating leftward, upward, and counterclockwise without fixation. H = horizontal position of the left eye, V = vertical position of the left eye, T = torsional position of the left eye. In each recording, upward deflection indicates rightward, upward, and clockwise eye motion. (B) Rightward ocular torsion is observed on fundus photos (normal range = 0-12.6O, positive values indicate an extorsion). (C) Bithermal caloric tests documented complete right canal paralysis. SPV = slow phase velocity, PSPV = peak SPV. (D) Ocular vestibular-evoked myogenic potential show no wave formation during right ear stimulation. (E) Pure-tone audiometry shows symmetric responses between the ears (Lt = left, Rt = right).
fneur-09-00311-g003.jpg
PMC5940739_02_fneur-09-00311-g003.jpg
F3
On evaluation 6 days after symptom onset, he showed SN nystagmus beating leftward, upward, and counterclockwise without fixation (Figure 3A). Rightward ocular torsion was observed on fundus photos (Figure 3B). Bithermal caloric tests showed complete right canal paralysis (Figure 3C). Ocular VEMPs showed no responses during right ear stimulation (Figure 3D), but findings of cervical VEMPs were symmetric. Audiometry was normal (Figure 3E). Brain MRIs disclosed a tiny acute infarction in the tail portion of left hippocampus (Figure 1, 3).