PP1503 - A Complex Case Study of a 74-Year-Old Male Patient with Ataxia and Vestibular Abnormalities

Abstract:
This audiology poster details a case study of a 74-year-old male with persistent chronic dizziness over 5-6 years. He experienced constant dizziness, varying in severity, alongside nausea, vomiting, cognitive fogginess, and ataxia, affecting his balance and coordination. Audiological assessment revealed bilateral sensorineural hearing loss. A review of an MRI conducted on June 28, 2022, revealed no evidence of retro cochlear pathology but indicated mild global atrophy. Vestibular tests revealed significant direction-changing vertical gaze-evoked nystagmus and right labyrinthine dysfunction. Despite vestibular rehabilitation, the patient's symptoms worsened. Referral to a neuro-ophthalmologist is strongly recommended for further evaluation of potential central nervous system involvement

Summary:
This audiology poster details a case study involving a 74-year-old male patient who sought evaluation for chronic dizziness persisting for 5 to 6 years, despite prior consultations with multiple healthcare providers, including a neurologist from outside the immediate area who did not provide a definitive diagnosis or treatment. The patient reported constant dizziness, varying in severity, along with symptoms of nausea, vomiting, cognitive fogginess, ataxia (neurological disorder affecting coordination and balance), unsteady movements, and difficulty with coordination. Audiological assessment revealed bilateral sensorineural hearing loss.
An MRI conducted on June 28, 2022, showed no evidence of retrocochlear pathology but indicated mild global atrophy. Comprehensive vestibular testing revealed significant issues, including vertical gaze-evoked nystagmus with direction changes and right labyrinthine dysfunction on both calorics and cVEMP testing. The presence of vertical gaze-evoked nystagmus in all gaze conditions raised concerns about central nervous system involvement.
Given the underlying right labyrinthine dysfunction, vestibular rehabilitation was recommended as a medically necessary intervention, alongside a second neurology consult and a neuro-ophthalmology consult. Unfortunately, the patient's symptoms worsened with vestibular rehabilitation, and the initiated Lacosamide treatment resulted in excessive fatigue without significant relief.
The presence of significant vertical gaze-evoked direction-changing nystagmus in all occulomotor conditions raises concerns about a midbrain lesion or cerebellar disorder. As a result, a referral to a neuro-ophthalmologist is strongly recommended for further evaluation and specialized testing to investigate potential central nervous system involvement.
This case study underscores the complexity of diagnosing and treating chronic dizziness, particularly when associated with ataxia and neurological symptoms. The audiological assessment, vestibular testing, and MRI findings provide valuable insights into the patient's condition. It highlights the importance of interdisciplinary collaboration involving audiologists, neurologists, and neuro-ophthalmologists in managing complex cases.
The rationale and purpose of this study are well-established, focusing on addressing a challenging medical issue that significantly impacts the patient's quality of life. The study's methodology, including audiological assessment, MRI, and vestibular testing, is clearly described, demonstrating an appropriate approach to investigating the patient's condition. The results, such as the presence of vertical gaze-evoked nystagmus and right labyrinthine dysfunction, are supported by the findings of the tests conducted.
The conclusions drawn from this case study are consistent with the results, emphasizing the need for further evaluation and specialized testing by a neuro-ophthalmologist due to concerns about central nervous system involvement. The overall clarity of the submission is commendable, with a coherent structure and clear presentation of information.
In terms of importance, this study addresses a critical issue affecting the patient's well-being, showcasing the significance of thorough evaluation and interdisciplinary collaboration. Additionally, the study demonstrates some level of innovation in diagnosing and managing complex cases of chronic dizziness and ataxia. Overall, this case study is a valuable contribution to the field of audiology and neurology, offering insights into the challenges and potential solutions for similar cases.