Mumbai January 24, 2023-In the complex realm of medical diagnosis, cases often present challenges that defy conventional expectations. This narrative unfolds with a case managed by Dr. Sheetal Goyal, a Senior Neurologist at Wockhardt Hospitals Mumbai Central, shedding light on an atypical presentation of sudden hearing loss.
The story commences with a middle-aged gentleman in his 50s, who arrives at the emergency room with an abrupt onset of severe right-sided hearing loss accompanied by intense rotational sensations and recurring episodes of vomiting. Dr. Goyal, alerted by the severity of the symptoms, initiated a prompt investigation.
The patient underwent an MRI Brain with MR angiography as part of the diagnostic protocol. Surprisingly, the results revealed no anomalies. However, Dr. Goyal, vigilant in her examination, noted a blood glucose level of 300 mg/dl, promptly controlled with Injection Insulin. Seeking ENT consultation, the plan was to administer injection steroids to address the presumed ear-related cause of sudden hearing loss.
Upon examination, Dr. Goyal observed nystagmus with a distinctive rotational component and mild facial numbness on the right side. These neurological signs raised concerns, challenging the notion that the sudden hearing loss was solely an ear problem. Despite the absence of immediate findings on the initial MRI, the patient was treated under Dr. Goyal’s care as a potential stroke case, and steroid administration was withheld.
A repeat MRI conducted after two days delivered a revelation – an infarct in the AICA (Anterior Inferior Cerebellar Artery) territory. The diffusion restriction and corresponding ADC changes were evident in the right cerebellar parenchyma, right middle cerebellar peduncle, and posterolateral pons. Strikingly, classic stroke symptoms like facial weakness and Horner syndrome were absent, contributing to the complexity of the diagnostic puzzle.
This case emphasizes the need for a broad understanding of stroke presentations beyond conventional symptoms. Holistic evaluation, guided by intertwining patient complaints, proves crucial in achieving accurate diagnoses, revealing the interconnected nature of symptoms. It challenges the belief that all hearing loss cases are ear-related, advocating for a broader diagnostic perspective considering nuanced neurological complexities. Additionally, the case questions the presumed infallibility of MRI Brain in diagnosing strokes, endorsing a clinical approach that treats evident strokes, even without immediate radiological confirmation. Dr. Sheetal Goyal’s management underscores the importance of a nuanced perspective in navigating medical complexities, contributing to the evolving understanding of stroke presentations and promoting a holistic approach in healthcare.