Evaluation of Vestibular Functions in Patients with Vogt-Koyanagi-Harada Disease

A Case of Vogt-Koyanagi-Harada Disease: Diagnosis Based on the Presence of Vitiligo and Sunset Glow Fundus Without Ocular Symptoms

Vogt-Koyanagi-Harada disease is an autoimmune disease affecting melanocytes. We report a case of Vogt-Koyanagi-Harada disease where the diagnosis was based on the presence of vertigo, vitiligo, and sunset glow fundus without ocular symptoms. The patient was a 68-year-old woman with a history of type 1 diabetes mellitus who developed vertigo three months prior and vitiligo on the face and arms two months prior. An ophthalmic examination revealed sunset glow fundus with numerous depigmented chorioretinal scars. Keratic precipitates were observed; however, no cells were observed in the anterior chamber. The patient had been examined by an ophthalmologist five years prior for a thorough evaluation of diabetic retinopathy; at that time, the fundus was normal in color. Based on the vertigo, vitiligo, and fundus findings, the patient was diagnosed as having convalescent Vogt-Koyanagi-Harada disease. Physicians should be aware that Vogt-Koyanagi-Harada disease is a potential cause of systemic symptoms, including vertigo, hearing loss, headache, nausea, and vitiligo.

Bilateral delayed endolymphatic hydrops evaluated by bilateral intratympanic injection of gadodiamide with 3T-MRI

The purpose of this study was to assess the diagnostic performance of 3T MRI after intratympanic injection of gadodiamide for delayed endolymphatic hydrops (DEH), and assess the relationship between endolymphatic hydrops (ELH) and vestibular function in patients diagnosed with DEH and confirmed by 3T MRI. Nineteen patients clinically diagnosed with DEH (11 ipsilateral DEH, 8 contralateral DEH) participated in this study. Diluted gadodiamide was administered to the bilateral tympanic cavity by injection through the tympanic membrane. At 24 hours post-injection, the ELH was evaluated by MRI. Patient vestibular functions were evaluated by caloric testing and cVEMP. ELH was observed in all patients (19/19: positive rate 100%). The distribution patterns of ELH varied between the cochlear or vestibular region. Vestibular ELH was observed in the affected ear in all ipsilateral DEH patients. In the contralateral DEH patients, however, there were individual differences in the distribution patterns of ELH. Six patients (1 ipsilateral DEH, 5 contralateral DEH) had bilateral ELH. No obvious relationships were observed between ELH and vestibular function. ELH distribution was complicated, particularly in the contralateral DEH cases. It was difficult to identify the existence of ELH by vestibular functional testing alone; therefore, 3T MRI is thought to be useful for identifying the affected ear. A significant number of cases had “bilateral” DEH, particularly among the contralateral DEH cases, indicating that we should pay careful attention to this pathology when treating DEH.