レルモワイエ症候群 : 症例とその発現機序
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概要
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Precise history taking and otoneurological examination confirmed the diagnosis of Lermoyezs syndrome.<BR>A 39-year-old male had been suffering from recurrent episodes of tinnitus, hearing loss and dizziness. The course of the symptoms were of interest. First, low-grade tinnitus and hearing loss persisted for a year. At the pre-stage of vertigo, he noticed the severity of tinnitus and hearing impairment was used to increase. Then, the attacks of dizziness appeared. Meanwhile, both tinnitus and hearing impairment disappeared after the sudden onset of vertigo. These symptoms reccurred with increasing frequency and severity. On the basis of our findings and a review of the literature, we conclude that the major cause of Lermoyez syndrome may be an abnormal flexibility of the ductus reuniens. The stages of onset might be as follows: an increase of endolymphatic pressure due to pathologic conditions similar to Menieres disease, probably due to narrowing of the flexible ductus reuniens. This would cause tinnitus and hearing loss.<BR>The higher the pressure of the cochlear endolymph, the worse the cochlear symptoms. Further increased pressure of the endolymphatic space would cause the ductus reuniens to open suddenly with a pop (before rupture of Reissners membrane, as noted by Lawrence and MaCabe in Menieres disease). A sudden pressure increase in the saccule induces an abrupt change of the macula nerve action potential, lowering the threshold of nystagmus and dizziness and leading to an episode of vertigo. Simultaneosly, the tinnitus disappears and hearing is restored.<BR>Further investigation is required.
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