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Case Reports
. 2014 Apr;18(2):168-71.

Middle fossa arachnoid cysts and inner ear symptoms: Are they related?

E Proimos  1 , Ts Chimona  1 , Z Memtsas  1 , Ce Papadakis  1
Affiliations
Case Reports

Middle fossa arachnoid cysts and inner ear symptoms: Are they related?

E Proimos et al. Hippokratia. 2014 Apr.

Abstract

Background: Arachnoid cysts most frequently occur in the middle cranial fossa and when they are symptomatic, patients present with central nervous symptoms. Nevertheless, a large proportion of arachnoid cysts are incidentally diagnosed during neuroimaging in cases with nonspecific symptoms.

Report of cases: The cases of two males with middle cranial fossa arachnoid cysts with nonspecific inner ear symptoms were retrospectively reviewed. The first patient presented with mild headache, nausea, vertigo, unsteadiness, and tinnitus on the left ear while the second patient's main complaint was left sided tinnitus. Both patients (initially managed for peripheral disorders) underwent a thorough clinical and electrophysiological evaluation. Because of the patients' persistent clinical symptoms, and indications of CNS disorder in the first case, neuroimaging by brain MRI was performed revealing a middle cranial fossa arachnoid cyst in both patients.

Conclusion: Occasionally, patients with arachnoid cysts may present with mild, atypical or intermittent and irrelevant symptoms which can mislead diagnosis. Otorhinolaryngologists should be aware of the fact that atypical, recurrent or intermittent symptoms may masquerade a CNS disorder. Hippokratia 2014; 18 (2):168-171.

Keywords: arachnoid cyst; atypical presenting symptoms; hearing loss; middle cranial fossa; tinnitus; vertigo.

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Figures

Figure 1
Figure 1. Pure tone audiogram of case 1 showing mild sensorineural hearing loss on the left and Auditory Brainstem Response (ABR) of case 1 revealing a slight prolongation of wave III absolute latency on the left is noticed (3.97 ms at stimulus intensity 90dBnHL). Wave V interaural latency difference is <0.2 ms.
Figure 2
Figure 2. Case 1 pathologic video-oculography recordings of A) smooth pursuit with low symmetric gain and continuous “catch-up” saccades B) saccades showing overshoot dysmetria.
Figure 3
Figure 3. Coronal and axial T1- weighted brain MRI brain MRI of case 1 showing a large arachnoid cyst occupying the left cranial fossa on the left.
Figure 4
Figure 4. Pure tone audiogram of case 2 showing a symmetric high frequency hearing loss
Figure 5
Figure 5. Axial T1-weighted brain MRI of case 2 showing a left anterior temporal arachnoid cyst
See this image and copyright information in PMC

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