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Acute Unilateral Hearing Loss as an Early Symptom of Lateral Cerebral Sinus Venous Thrombosis

Thomas Gattringer, MD; Christian Enzinger, MD; Armin Birner, MD; Gerit Wünsch, DSc; Kurt Niederkorn, MD; Christian Walch, MD; Franz Fazekas, MD
Arch Neurol. 2012;69(11):1508-1511. doi:10.1001/archneurol.2012.346.
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Background  Increasing availability of neuroimaging has facilitated the diagnosis of cerebral sinus venous thrombosis (CSVT). However, CSVT may also present with unspecific or atypical symptoms, resulting in diagnostic delay. Single reports suggested otologic symptoms as such pitfalls.

Objective  To screen patients with CSVT for otologic symptoms.

Design  Ten-year retrospective case series.

Setting  Primary and tertiary care university clinic.

Patients  Thirty-eight patients with CSVT.

Results  Of 38 patients with CSVT, 3 individuals had acute unilateral hearing loss, 2 of which also had concomitant tinnitus and headache, and were initially treated at the ear, nose, and throat department. Magnetic resonance imaging after hospital discharge showed ipsilateral thrombosis of the lateral venous sinus. Two female patients took oral contraceptives, 1 of whom also had a heterozygous factor V Leiden mutation.

Conclusions  Cerebral sinus venous thrombosis may present with unspecific symptoms such as acute unilateral hearing loss. If in conjunction with headache or risk factors for venous thrombosis, the suspicion of ipsilateral lateral CSVT should prompt rapid imaging including venography.

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Figure. Neuroimaging studies of patients demonstrating lateral cerebral sinus venous thrombosis (arrows) ipsilateral to acute hypacusis. Computed tomographic scan (A); axial fluid-attenuated inversion recovery images (B and E); sagittal, axial, and coronal T1-weighted images (D, G, and H, respectively); and venous magnetic resonance angiographic images (C, F, and I).

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