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Ye JJ, Bouffard MA, Brooks E, Hung YP, Kimchi EY. Giant Cell Arteritis Presenting With Multiple Cranial Neuropathies - Case Report. Neurohospitalist 2023; 13:188-191. [PMID: 37064934 PMCID: PMC10091440 DOI: 10.1177/19418744221139893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Vision loss accounts for most ophthalmic presentations of giant cell arteritis (GCA), but an important minority of patients present with diplopia and other cranial neuropathies. Case study: Here we present the case of an 84-year-old woman with a prior history of multiple cancers who was admitted to our hospital after developing double vision. She was found to have mydriasis, ptosis, and ophthalmoplegia in the right eye (OD) consistent with a combined R CNIII/CNVI neuropathy, as well as highly elevated inflammatory markers. Given her cancer history, the patient was initially worked up for various neoplastic, paraneoplastic, inflammatory, and infectious causes of multiple cranial neuropathies; however, as these results were negative, GCA became a more likely contender as a possible rare cause of multiple cranial neuropathies. The patient underwent temporal artery biopsy which showed pathology consistent with giant cell arteritis, and she was treated with steroids with eventual improvement in ophthalmoplegia and ptosis. Conclusions: This case illustrates the importance of recognizing GCA as a rare possible cause of multiple cranial neuropathies, including the indispensable role of temporal artery biopsy.
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Affiliation(s)
- Jessica J. Ye
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Marc A. Bouffard
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Earllondra Brooks
- Department of Neurology, Emory University Hospital, Atlanta, GA, USA
| | - Yin P. Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Eyal Y. Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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De Fontcuberta P, Vandenhende MA, Laux M, Tourbier B, Paz R, Bonnet F, Meriglier E. [Hearing loss in giant cell arteritis: A case report]. Rev Med Interne 2023; 44:31-34. [PMID: 35752483 DOI: 10.1016/j.revmed.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Hearing loss is a rare manifestation in giant cell arteritis. The different types of deafness are possible with a predominance of sensorineural deafness. CASE REPORT We report a 75-year-old woman who presented with typical manifestations of giant cell arteritis associated concomitantly with the occurrence of bilateral mixed hearing loss confirmed on the audiogram. Corticosteroids allowed a rapidly favorable clinical and biological outcome. The follow-up audiogram at 3 months was markedly improved and showed a decrease in sensorineural hearing loss and disappearance of conductive hearing loss. CONCLUSION Any rapid onset deafness in an inflammatory context in the elderly should lead to a search for giant cell arteritis. The diagnosis can be difficult in the absence of other typical manifestations, especially since the biopsy of the temporal artery most often comes back negative. Corticosteroids are usually effective.
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Affiliation(s)
- Pedro De Fontcuberta
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Marie-Anne Vandenhende
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France; Université de Bordeaux, Talence, France
| | - Miranda Laux
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Benjamin Tourbier
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Rafael Paz
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Fabrice Bonnet
- Université de Bordeaux, Talence, France; Service de médecine interne et maladies infectieuses, hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - Etienne Meriglier
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France; Université de Bordeaux, Talence, France.
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Soulages A, Sibon I, Vallat JM, Ellie E, Bourdain F, Duval F, Carla L, Martin-Négrier ML, Solé G, Laurent C, Monnier A, Le Masson G, Mathis S. Neurologic manifestations of giant cell arteritis. J Neurol 2022; 269:3430-3442. [DOI: 10.1007/s00415-022-10991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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李 熙, 陈 雨, 张 光, 崔 卫. [Immune-mediated sensorineural hearing loss: prevalence and treatment strategies]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:663-667. [PMID: 32791649 PMCID: PMC10133116 DOI: 10.13201/j.issn.2096-7993.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 06/11/2023]
Abstract
Autoimmune sensorineural hearing loss is a rare clinical entity which accounting for less than 1% in all cases with hearing loss. The prevalence of hearing loss in immune-mediated inner ear diseases, as shown in case reports or single-center statistics, varies widely. We reviewed the current literatures on the association between sensorineural hearing loss and autoimmune diseases, focused on the prevalence of hearing loss in different autoimmune diseases, treatments and challenges.
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Affiliation(s)
- 熙星 李
- 河北医科大学第二医院耳鼻咽喉头颈外科(石家庄,050000)
| | - 雨濛 陈
- 河北医科大学第二医院耳鼻咽喉头颈外科(石家庄,050000)
| | - 光远 张
- 河北医科大学第二医院耳鼻咽喉头颈外科(石家庄,050000)
| | - 卫娜 崔
- 河北医科大学第二医院耳鼻咽喉头颈外科(石家庄,050000)
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5
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[Giant cell arteritis: Ischemic complications]. Presse Med 2019; 48:948-955. [PMID: 31564551 DOI: 10.1016/j.lpm.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
GCA ischemic complications occur generally in patients with a yet undiagnosed or uncontrolled disease. When disease control is fair, ischemic complications may be due mostly to atheromatosis. Ophtalmic complications are most frequent and are dominated by anterior ischemic optic neuropathy. Vasculitic strokes occur essentially in the vertebrobasilar arterial territory. Overt vasculitic coronary disease is exceptional. The diagnosis of upper and lower limbs ischemic complications benefit from advances in echography (halo sign) and positron emission tomography imaging. Treatment relies on corticosteroids (initially 1mg/kg prednisone or more, preceded by intravenous methylprednisolone gigadoses if necessary), the control of cardiovascular risk factors and antiplatelet drugs; heparin may be indicated for threatening limbs ischemia.
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Saravanan V, Pugmire S, Smith M, Kelly C. Patient-reported involvement of the eighth cranial nerve in giant cell arteritis. Clin Rheumatol 2019; 38:3655-3660. [PMID: 31420810 DOI: 10.1007/s10067-019-04747-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/29/2019] [Accepted: 08/08/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The frequency of eighth nerve lesions in patients with giant cell arteritis (GCA) has rarely been examined. However, sudden onset deafness has been recorded as a presenting feature of GCA on several occasions. This study sought to establish how common this and other symptoms of eighth nerve involvement are in a large retrospective survey. METHODS We contacted 170 patients with GCA and 250 matched PMR patients, inviting them to participate in a questionnaire survey of symptoms of eighth nerve dysfunction. We compared the presence of deafness, tinnitus, loss of balance and vertigo in both groups and examined the relationship between the onset of these symptoms and other features of GCA. RESULTS A total of 317 patients were recruited. The percentage of patients with symptoms of possible vestibulocochlear disease prior to commencement of steroid therapy was significantly greater among GCA patients than PMR patients for all domains. Hearing loss which was twice as common in GCA as in PMR (53% vs 26%) [p = 0.001]. Deafness was concurrent in 35% of GCA patients with other symptoms and 45% reported colocation with headache. Recovery with steroids occurred in 56% of these. CONCLUSION Symptoms of eighth nerve dysfunction are present in over half of patients with GCA. Recovery with steroids was predicted by concurrence with headache in terms of both timing and location. It appears that eighth nerve involvement, especially acute hearing loss, is a not infrequent feature of GCA and often responds well to steroid therapy. Clinicians should enquire about these symptoms when evaluating a patient for possible GCA.Key Points• Deafness is a frequent presenting feature of giant cell arteritis.• Vertigo, tinnitus and loss of balance are also often reported by GCA sufferers.• Steroid therapy is more likely to relieve these symptoms if they are ipsilateral and concurrent with headache.
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Affiliation(s)
- Vadivelu Saravanan
- Department of Rheumatology, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - Susan Pugmire
- Department of Rheumatology, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - Mavis Smith
- Department of Rheumatology, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - Clive Kelly
- Department of Rheumatology, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK.
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Chu X, Wang D, Zhang Y, Yin Y, Cao Y, Han X, Shen M, Jiang H, Zeng X. Comparisons of clinical manifestations and prognosis between giant cell arteritis patients with or without sensorineural hearing loss: A retrospective study of Chinese patients. Medicine (Baltimore) 2019; 98:e15286. [PMID: 31027087 PMCID: PMC6831369 DOI: 10.1097/md.0000000000015286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Auditory manifestations has rarely been mentioned in studies concerning giant cell arteritis (GCA). This study explores the proportion of hearing loss (HL) in Chinese GCA patients and investigates the differences in clinical features between GCA patients with and without HL.The study retrospectively reviewed the clinical records of 91 patients diagnosed with GCA at Peking Union Medical College Hospital (PUMCH) from November 1998 to October 2017. GCA diagnoses were reconfirmed according to the American College of Rheumatology 1990 criteria. Diagnosis of HL was made based on a patient's symptoms combined with physical examination or ear-nose-throat (ENT) audiometry tests. Subgroup analysis was conducted according to the occurrence of HL.Totally 23 patients (25.3%) had HL. A higher percentage of males (65.2% vs 38.2%, p = 0.025) was seen in HL group. Symptoms such as headache (91.3% vs 61.2%, p = 0.011), visual loss (56.5% vs 32.4%, p = 0.039) and CNS symptoms (39.1% vs 17.6%, p = 0.035) were more frequent in HL group. Moreover, they were more likely to have smoking history (p = 0.019), lower lymphocyte count (p = 0.049), positive ANA or APL (p = 0.047, p = 0.017) or negative biopsy results (p = 0.015). Symptom like myalgia (26.1% vs 66.2%, p = 0.001) as well as comorbid disease like coronary artery disease (p = 0.037) and hypertension (p = 0.040) was more frequent in patients without HL. Either C-reactive protein (90.91 ± 65.86 vs 76.05 ± 61.15 mg/L, p = 0.347) or erythrocyte sedition rate (83.04 ± 29.61 vs 93.69 ± 26.78 mm/h, p = 0.136) was high in both groups but the differences were not significant. Meanwhile, no significant differences were found in age, disease course, vascular involvement or prognosis between the two groups. Unilateral HL tended to happen at the same side with unilateral headache, visual loss, scalp tenderness or jaw claudication.HL is probably not rare in GCA patients and is more frequently to be seen in patients presented with headache, visual loss or CNS symptoms. Differentiation of HL is necessary for specialists and GCA should be considered as a potential diagnosis especially in HL patients with high inflammatory markers. Auditory assessment should be conducted in GCA management.
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Affiliation(s)
- Xiaotian Chu
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Dongmei Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Yun Zhang
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Yue Yin
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Yu Cao
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Xinxin Han
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | | | - Hong Jiang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xuejun Zeng
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
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Le N, Vickers A, Prospero Ponce C, Chevez-Barrios P, Lee AG. Vestibulocochlear symptoms as the initial presentation of giant cell arteritis. Can J Ophthalmol 2019; 54:e1-e3. [PMID: 30851784 DOI: 10.1016/j.jcjo.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/28/2018] [Accepted: 04/06/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Nhon Le
- Baylor College of Medicine, Houston, Texas
| | - Aroucha Vickers
- Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Claudia Prospero Ponce
- Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Patricia Chevez-Barrios
- Baylor College of Medicine, Houston, Texas; Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Departments of Pathology and Laboratory Medicine and Ophthalmology, Weill Cornell Medicine, New York, N.Y
| | - Andrew G Lee
- Baylor College of Medicine, Houston, Texas; Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, N.Y; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center, Houston, Texas; Texas A & M College of Medicine, Bryan, Texas; Weill Cornell Medicine; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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9
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Fazel MT, Jedlowski PM, Cravens RB, Erstad BL. Evaluation and Treatment of Acute and Subacute Hearing Loss: A Review of Pharmacotherapy. Pharmacotherapy 2017; 37:1600-1616. [DOI: 10.1002/phar.2044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Maryam T. Fazel
- Department of Pharmacy Practice & Science; College of Pharmacy, University of Arizona; Tucson Arizona
- Department of Medicine; College of Medicine - Tucson, University of Arizona; Tucson Arizona
| | | | | | - Brian L. Erstad
- Department of Pharmacy Practice & Science; College of Pharmacy, University of Arizona; Tucson Arizona
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Junejo S, Ali Y, Abrudescu A. Giant Cell (Temporal) Arteritis with Persistent Bilateral Sensorineural Hearing Loss - A Likely Consequence of Delayed Institution of Glucocorticoid Therapy. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1233-1237. [PMID: 29186088 PMCID: PMC5706380 DOI: 10.12659/ajcr.907174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 66 Final Diagnosis: Giant cell arteritis Symptoms: Hearing loss Medication: — Clinical Procedure: — Specialty: Rheumatology
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Affiliation(s)
- Shoaib Junejo
- , Icahn School of Medicine at Mount Sinai-Queens Hospital Center, Jamaica, NY, USA
| | - Yasir Ali
- Department of Endocrinology, NYC Health and Queens Hospital Center, Jamaica, NY, USA
| | - Adriana Abrudescu
- , Icahn School of Medicine at Mount Sinai-Queens Hospital Center, Jamaica, NY, USA
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Wirth M, Schirmer L, Hofauer B, Lenschow M, Loos D, Thuermel K, Knopf A. Head and neck giant cell arteritis: an autoimmune disease with many faces. Acta Otolaryngol 2017; 137:986-991. [PMID: 28440088 DOI: 10.1080/00016489.2017.1314010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONCLUSION A high rate of infrequent presentations of giant cell arteritis were seen in the ENT department and should be anticipated as a differential diagnosis in every older patient with odynophagia with high CRP values without cause in thorough ENT examination. OBJECTIVE To describe the clinical manifestation of head and neck giant cell arteritis and to derive a diagnostic pathway covering atypical cases. METHOD Single-center, retrospective analysis of cases with GCA in the head and neck region (HN-GCA) (2002-2012) to describe the clinical presentation and to derive a diagnostic pathway covering manifestations presenting to an ENT department. RESULTS Sixty-five patients were newly diagnosed with HN-GCA in the department of otolaryngology, ophthalmology and neurology. The most frequent symptoms were loss of vision (83%) and new onset headache (63%). Eight patients (12%) presented with infrequent manifestations, predominantly in the department of otorhinolaryngology. The most common atypical presentation (50%) was odynophagia in conjunction with high CRP values misleading to an infectious cause and delaying diagnosis. A diagnostic pathway for GCA was derived based on the ACR classification criteria and the clinical findings.
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Affiliation(s)
- Markus Wirth
- Department of Otolaryngology – Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lucas Schirmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Hofauer
- Department of Otolaryngology – Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Magdalena Lenschow
- Department of Otolaryngology – Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daria Loos
- Department of Ophthalmology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Klaus Thuermel
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Knopf
- Department of Otolaryngology – Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Mirvakili A, Dadgarnia MH, Baradaranfar MH, Atighechi S, Zand V, Ansari A. Role of Platelet Parameters on Sudden Sensorineural Hearing Loss: A Case-Control Study in Iran. PLoS One 2016; 11:e0148149. [PMID: 26829393 PMCID: PMC4734775 DOI: 10.1371/journal.pone.0148149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/13/2016] [Indexed: 01/05/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is a common otological disorder characterized by a hearing loss greater than 30 dB over three consecutive frequencies, in less than 72 hours. It has been established that platelet parameters, such as mean platelet volume, are associated with ischemic heart events, whose clinical manifestations are similar to those of SSNHL. Hence, we aimed to determine if the platelet count, mean platelet volume and platelet distribution width are related to the occurrence and severity of sudden sensorineural hearing loss. A case-control prospective study was conducted in a teaching hospital in Iran. One hundred-eight patients with SSNHL and an equal number of healthy, age- and sex-matched controls were enrolled in the study. Peripheral venous blood samples were collected from the subjects, and the platelet count, mean platelet volume and platelet distribution width were measured with an automated blood cell counter. Analysis of the audiometry and hematological test results using SPSS22 software showed no statistical correlation between the platelet parameters and the occurrence of SSNHL, but correlation coefficients showed a significant correlation between PDW and hearing loss severity in patients group. However, further investigation is required to unequivocally establish the absence of correlation between the platelet parameters and occurrence of SSNHL.
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Affiliation(s)
- Abbas Mirvakili
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Mohammad Hossein Dadgarnia
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Mohammad Hossein Baradaranfar
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Saeid Atighechi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Vahid Zand
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Abdollah Ansari
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
- * E-mail:
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13
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Sudden sensorineural hearing loss: when is it idiopathic? The Journal of Laryngology & Otology 2010; 124:690-3. [DOI: 10.1017/s0022215109992064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective: To highlight the importance of assessing the certainty of a diagnosis of idiopathic sudden sensorineural hearing loss, and of modifying patient management accordingly.Case report: A patient presented with sudden sensorineural hearing loss in the right ear. Following assessment and preliminary investigation, a diagnosis of idiopathic sudden sensorineural hearing loss was made. Steroid treatment was commenced. Two weeks later, the patient experienced sudden sensorineural hearing loss in the left ear, and scalp tenderness. Subsequent biopsy confirmed giant cell arteritis.Conclusions: Management of idiopathic sudden sensorineural hearing loss should be guided by the level of certainty of diagnosis. If there is relative uncertainty, risk factors for specific diagnoses should be sought, the patient should be followed more closely, and investigation should be tailored appropriately. Giant cell arteritis should be considered in patients older than 50 years, those exhibiting suggestive signs or symptoms, and those with elevated inflammatory markers or deranged liver function tests.
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14
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Stone JH, Papaliodis GN, Dunbar MR, Stone JR. Case records of the Massachusetts General Hospital. Case 4-2010. A 53-year-old man with arthralgias, oral ulcers, vision loss, and vocal-cord paralysis. N Engl J Med 2010; 362:537-46. [PMID: 20147720 DOI: 10.1056/nejmcpc0910090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- John H Stone
- Department of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, USA
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Loffredo L, Parrotto S, Violi F. Giant cell arteritis, oculomotor nerve palsy, and acute hearing loss. Scand J Rheumatol 2009; 33:279-80. [PMID: 15370728 DOI: 10.1080/03009740410006178] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Hervier B, Bordure P, Masseau A, Calais C, Agard C, Hamidou M. [Auto-immune sensorineural deafness: physiopathology and therapeutic approach]. Rev Med Interne 2009; 31:222-8. [PMID: 19233519 DOI: 10.1016/j.revmed.2008.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 11/29/2008] [Accepted: 12/10/2008] [Indexed: 12/17/2022]
Abstract
Sensorineural hearing loss may be due to an autoimmune mechanism. The mechanisms that could induce autoimmune inner ear damage are now better understood, but are not exclusive. Moreover, there is no specific immunologic test available for the diagnosis of autoimmune sensorineural hearing loss, which could also complicate the disease course of other autoimmune systemic diseases. Thus, the incidence of sensorineural autoimmune hearing loss is probably underestimated. The aim of this study was to review the experimental immunologic data in favour of an autoimmune mechanism in this subgroup of sensorineural hearing loss: humoral specific response against inner ear (autoantibodies against a transmembrane transporter) and also cellular response (against cochlin: one of the major proteins expressed in the inner ear). The aim of this review was also to focus on clinical and epidemiological human data that provide evidence for an autoimmune etiopathogeny of some sensorineural hearing loss. Therapeutic options such as immunosuppressive treatments (oral corticosteroids and other immunosuppressive drugs, such as methotrexate and anti-TNFalpha) are also discussed.
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Lidar M, Carmel E, Kronenberg Y, Langevitz P. Hearing Loss as the Presenting Feature of Systemic Vasculitis. Ann N Y Acad Sci 2007; 1107:136-41. [PMID: 17804541 DOI: 10.1196/annals.1381.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hearing loss, both sensorineural and conductive, is a well-recognized manifestation of systemic vasculitis, yet has only infrequently been described as its initial presentation. We describe three cases in which hearing loss preceded the diagnosis of systemic vasculitis by a period of a few weeks to more than 6 months. While steroid therapy was initiated immediately in one of the cases, comprehensive immunosuppressive therapy was given only after additional manifestations compatible with vasculitis appeared, allowing for a diagnosis of Wegener's granulomatosis in two of the cases and undifferentiated vasculitis, in the third. Hearing improved in all patients, albeit, residual dysfunction remained. Prompt referral for a complete rheumatologic workup in cases of unexplained hearing loss would allow for a timely diagnosis of a collagen vascular disease and facilitate early initiation of systemic therapy, possibly yielding better audiological results.
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Affiliation(s)
- Merav Lidar
- Department of Internal Medicine F and Rheumatic Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
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Amor-Dorado JC, Llorca J, Garcia-Porrua C, Costa C, Perez-Fernandez N, Gonzalez-Gay MA. Audiovestibular manifestations in giant cell arteritis: a prospective study. Medicine (Baltimore) 2003; 82:13-26. [PMID: 12544707 DOI: 10.1097/00005792-200301000-00002] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Giant cell arteritis (GCA) is a multisystemic vasculitis of elderly people that involves large and medium-sized blood vessels with predisposition to the cranial arteries. Some cranial ischemic manifestations, in particular permanent visual loss, have been widely described. Audiovestibular manifestations have been less commonly reported. In the present study we assessed the frequency and outcome of audiovestibular manifestations in a series of GCA and isolated polymyalgia rheumatica (PMR) patients examined prospectively between June 1999 and May 2001 at the single hospital for a defined population. Patients were included in the study if a temporal artery biopsy had been performed and they were examined within a week after beginning corticosteroid treatment. Patients with abnormal otoscopy or tympanogram, history of cerebrovascular complications, syphilis, Ménière and other vestibular syndromes, infections involving the inner ear, barotrauma, or being treated with ototoxic drugs were excluded. During the study period 44 patients with GCA and 10 patients with biopsy-negative isolated PMR were examined. Patients with isolated PMR were younger. Audiovestibular dysfunction was significantly more frequent in GCA patients than in those with isolated PMR and matched controls. Almost 90% of the GCA patients had vestibular dysfunction, which was generally reversible after several days of steroid treatment; after 3 months of treatment, vestibular dysfunction was observed in only 13 (29.6%) of the 44 GCA patients. These patients with persistent vestibular dysfunction were more likely to have persistent head-shaking nystagmus. Twelve (27.3%) of the 44 GCA patients had hearing improvement after 3 months of therapy. After 6 months of therapy, only 1 of the 44 GCA patients had abnormal vestibular tests. However, no additional improvement in hearing function was observed. The present study confirms a high frequency of audiovestibular manifestations in GCA. It also suggests that audiovestibular damage may be reversible in some patients with GCA.
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Flammer J, Pache M, Resink T. Vasospasm, its role in the pathogenesis of diseases with particular reference to the eye. Prog Retin Eye Res 2001; 20:319-49. [PMID: 11286896 DOI: 10.1016/s1350-9462(00)00028-8] [Citation(s) in RCA: 255] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vasospasm can have many different causes and can occur in a variety of diseases, including infectious, autoimmune, and ophthalmic diseases, as well as in otherwise healthy subjects. We distinguish between the primary vasospastic syndrome and secondary vasospasm. The term "vasospastic syndrome" summarizes the symptoms of patients having such a diathesis as responding with spasm to stimuli like cold or emotional stress. Secondary vasospasm can occur in a number of autoimmune diseases, such as multiple sclerosis, lupus erythematosus, antiphospholipid syndrome, rheumatoid polyarthritis, giant cell arteritis, Behcet's disease, Buerger's disease and preeclampsia, and also in infectious diseases such as AIDS. Other potential causes for vasospasm are hemorrhages, homocysteinemia, head injury, acute intermittent porphyria, sickle cell disease, anorexia nervosa, Susac syndrome, mitochondriopathies, tumors, colitis ulcerosa, Crohn's disease, arteriosclerosis and drugs. Patients with primary vasospastic syndrome tend to suffer from cold hands, low blood pressure, and even migraine and silent myocardial ischemia. Valuable diagnostic tools for vasospastic diathesis are nailfold capillary microscopy and angiography, but probably the best indicator is an increased plasma level of endothelin-1. The eye is frequently involved in the vasospastic syndrome, and ocular manifestations of vasospasm include alteration of conjunctival vessels, corneal edema, retinal arterial and venous occlusions, choroidal ischemia, amaurosis fugax, AION, and glaucoma. Since the clinical impact of vascular dysregulation has only really been appreciated in the last few years, there has been little research in the according therapeutic field. The role of calcium channel blockers, magnesium, endothelin and glutamate antagonists, and gene therapy are discussed.
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Affiliation(s)
- J Flammer
- University Eye Clinic Basel, Mittlere Strasse 91, CH-4012, Basel, Switzerland.
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Liozon E, Herrmann FR, Ly K, Jauberteau MO, Loustaud V, Soria P, Robert PY, Liozon F, Vidal E. [Risk factors for irreversible cerebral ischemia complications from Horton's disease: prospective study of 178 patients]. Rev Med Interne 2001; 22:30-41. [PMID: 11218296 DOI: 10.1016/s0248-8663(00)00283-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To search for risk factors of developing irreversible cranial ischemic complications (ICIC) in patients with giant cell arteritis (GCA) and to explore whether two subsets of patients (high risk and low risk of developing ICIC) can be defined. METHODS One-hundred seventy-eight consecutive patients with temporal arteritis (149 biopsy-proven) were diagnosed and followed up in a department of Internal Medicine between 1976 and 1999. The patients were separated into two groups, according to the presence or absence of ICIC, with comparison of 17 clinical and biological parameters prospectively recorded for each patient using a pre-established comprehensive questionnaire. RESULTS ICIC occurred in 25 patients (14%), with amaurosis in 22 cases. Suggestive symptoms and/or signs of temporal arteritis were present in 92% of the patients, lasting 50 days (median) before the onset of ICIC. Forty-three patients (24%) complained of transient visual ischemic symptoms (TVIS), which preceded acute blindness in 11 cases. A multivariate logistic regression, from which 28 cases with upper limb artery involvement were excluded for technical reasons (no CCII in any case, thus predicting perfectly the lack of ischemic risk, P = 0.02), indicated that the only independent variables associated with the ischemic risk were: a history of TVIS (P = 0.05), the lack of signs of polymyalgia rheumatica (PMR; P = 0.02), lower blood levels of fibrinogen (P = 0.024) and higher mean blood platelets levels (P = 0.006). However, these five variables predicted only 30% of the variability of the model. Sensitivity, specificity, positive and negative predictive values of the model reached respectively 36, 96, 64 and 88%. Overall, 86% of the cases were correctly classified with respect to the ischemic risk. CONCLUSION The rate of ICIC should be reduced by an earlier recognition of the usual signs of temporal arteritis. Several independent risk factors of ICIC have been identified. However, the logistic model failed to predict accurately the ischemic risk in 14% of the cases, indicating that as yet unrecognised factors probably exist that play a role in the occurrence of ICIC. Nevertheless, regarding the strong association between platelet levels and ICIC, patients with thrombocytosis should receive initially both corticosteroids and antiplatelet agents.
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Affiliation(s)
- E Liozon
- Service de médecine interne A, hôpital Dupuytren, CHRU, 2, rue Martin-Luther-King, 87042 Limoges, France
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Abstract
Vascular inflammation stands at the center of innumerable physiological and pathological processes. Dissecting the mechanisms of successful vascular injury and repair, investigators provide information for scientists and clinicians. The neurologist benefits from studies across several disciplines. Details of the cellular functions in the infiltrates of temporal arteries impart a basis for rational therapy. The interactions of herpes virus with vessels wall remind us of the affinity of numerous infectious agents for the vasculature. Several animal models are enabling us to explore the genetic links in autoimmunity. Although clinical studies may not yet provide us with answers for accurate diagnosis and treatment of many of our patients, data from this year will keep our interest high.
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Affiliation(s)
- P M Moore
- Department of Neurology, University of Pittsburgh, Pennsylvania 15213, USA
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