MENIERE’S DISEASE & NEUROVASCULAR CROSS-COMPRESSION: CASE REPORT

Abstract

Meniere’s disease is typically characterized by the classic symptomatological triad consisting of vertigo associated with nausea and vomiting, fluctuating but progressive hearing loss, and tinnitus. The main pathophysiological substrate of Meniere's disease is certainly endolymphatic hydrops, the etiology of which is probably multifactorial, but still not completely understood. Recently, it has been shown that vertigo, hearing loss, and tinnitus can be the result of a vascular loop impinging on the VIIIth nerve and giving rise to the symptomatological complex that can been defined as Meniere's disease due to ‘cochleovestibular nerve compression syndrome’ (CNCS). In this cases the surgical technique of choice is the decompression of the cochleovestibular nerve but this surgical treatment would not have led to relief of vestibular symptoms in the patients with chronic Meniere's disease associated with vascular cross-compression; infact it has been demonstrated that due to mechanical compression the vestibular nerve present severe ultrastructural alterations with an irreversible degeneration of the root entry zone (malacic area). The Authors present an unusual case of chronic Meniere's disease due to a vascular cross-compression between the posterior inferior cerebellar artery (PICA) and the VIIIth nerve associated with a malacic area of the root entry zone in which, according to the patient, an experimental innovative pharmacological treatment, based on beta blockers (metoprolol), thiazide diuretic (chlortalidone) and equivalent medicines (ginko biloba; CDP-choline; vitamins A, B1, B2, B6, B12, E; magnesium; selenium; zinc; L-arginine) improving the metabolism of the central nervous system and of the labyrinth obtained a reduction of vestibular and auditory symptomatology.