April 4, 2019
A 47-year-old woman with a previous history of benign paroxysmal positional vertigo presented with sudden onset of hearing loss in the left ear followed by vertigo.
Intralabyrinthine Hemorrhage
- Background
- The etiology of sudden sensorineural hearing loss (SSNHL) remains unclear in most cases.
- Intralabyrinthine hemorrhage (ILH) is a rare cause of SSNHL.
- ILH has been associated with sickle cell disease, trauma, anticoagulant therapy, endolymphatic sac tumors or labyrinthitis.
- MRI is an established diagnostic modality in the evaluation of SSNHL.
- Clinical Presentation
- SSNHL +/- vertigo and tinnitus.
- Key Diagnostic Features
- High intensity on T1 weighted image due to methemoglobin during subacute period within normally fluid-filled space of labyrinth.
- Differential Diagnosis
- Increased signal in association with acoustic schwannoma: Hyperintensity on T1 due to high protein content, often postoperative.
- Intralabyrinthine schwannoma: T1 hyperintense without contrast only if hemorrhagic schwannoma (rare).
- Intralabyrinthine lipoma: Hyperintense signal on T1 but not typically associated with sudden hearing loss. Hypointensity on T1 MRI with fat suppression.
- Treatment
- Treatment of underlying condition; oral or intratympanic steroid treatment.
