pt 20yo f, MRI with and w/out contrast ordered before diagno | Figure 1

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Patient Presentation

pt 20yo f, MRI with and w/out contrast ordered before diagnosing possible meniere's disease. pt complains of headache, dizziness, ear fullness, ringing sounds, and balance issues. Looking to upload full MRI soon, these are the only images I have as of now. Sorry for poor quality, but so far do you spot anything? Better images to come.

Case Overview

A 38-year-old woman comes to your office with a 1-year history of episodic dizziness, ringing in both ears, a feeling of aural fullness, and hearing loss. The symptoms come on every 1 or 2 weeks and usually last for 12 hours. Nausea and vomiting are present. When asked to describe the dizziness, the patient says, “The world is spinning around me.”

On physical examination, the patient has horizontal nystagmus. The slow phase of the nystagmus is to the left, and the rapid phase is to the right. Audiograms reveal bilateral sensorineural hearing loss in the low frequencies.

What is the most likely diagnosis in this patient?

• a. vestibular neuronitis
• b. acute labyrinthitis
• c. positional paroxysmal vertigo
• d. orthostatic hypotension
• e. Ménière disease

Previous Case Update

Update to previous case on #Vertigo– Sx: dizziness, occasional diplopia, pulsatile tinnitus while prone. Dizziness is worsened while going from sitting to standing and lying down to sitting. ENT exam was negative. No nystagmus. HallPike negative. ENT ruled out BPPV, neuritis, labyrinthitis or other ENT etiologies. ENT ordered brain MRI and MR angiogram of head (because of pulsatile tinnitus). Angiogram was negative. Here are a few slides from the brain MRI.

Another Case Presentation

60 yo pt with left monoparesis. MRI T1, T2 with #Hernia on L4-5. Contrast MRI shows this image. Possible Dx?

Case Review

Axial post contrast image in a 20 month old with bacterial meningitis and new onset hearing loss shows abnormal enhancement in the internal auditory canals and labyrinthine structures (red arrows) in acute labyrinthitis. Bilateral involvement is more common in bacterial meningitis with unilateral more so in viral and trauma. The child was treated with bilateral cochlear implants. #NeuroWednesday

Emerging Cases

• A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?