Neurotological Findings in a Patient with Clivus Meningioma.

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A 51-year-old female presented with bilateral high-pitched tinnitus of approximately 6 years' duration, during which period she had visited several otolaryngologists without relief. Examination revealed a mild left hearing loss but was otherwise normal. The patient subsequently related a 3-year history of staggering gait with a tendency to fall to the left and difficulty with intentional movements and numbness of her left hand, all of which were transient, episodic and reversible. These episodes strongly suggested an intracranial lesion rather than a peripheral inner ear disorder, necessitating a more detailed neurotologic examination. The patient had a normal Romberg test and slight imbalance to the left side on Mann's test. Routine position testing exhibited vertical nystagmus through Frenzel's spectacles. Electronystagmography revealed saccadic pursuit, recorded with CETT (Circular Eye Tracking Test), and an inhibited left OKP (Optokinetic Pattern test). These neurotological findings suggested pathologic changes in the left posterior cranial fossa. Computed tomography and magnetic resonance studies showed a large, spherical space-oc-cupying lesion in the posterior cranial fossa. The final diagnosis of clivus meningioma was made during cranialsurgery. This case illustrates the importance of a careful detailed history and neurotological examinations if suggested by the history.
耳鼻咽喉科臨床学会の論文