case_images: PMC10806776_01
case_images: MRI and video head impulse testing. (A, B) Early MRI brain <24 hours was normal, with no labyrinthine enhancement on either the fluid-attenuated inversion recovery (FLAIR) (A) or T1 non-contrast (B) sequences. (C, D) Delayed MRI brain and internal auditory canal (IAC) on day 7 demonstrates hyperintensity within the left cochlea and semicircular canals (red arrows) on brain FLAIR (C) and IAC T1 precontrast (D) sequences, consistent with labyrinthine haemorrhage. (E-J) Video head impulse testing demonstrating hypofunction of the left anterior (G) and posterior (I) semicircular canals with significantly reduced vestibular ocular reflex gains (ie, eye velocity (green) is slower than head velocity (blue) in the opposite direction). There are overt corrective saccades (red spikes) in the left posterior canal.
case_images: bmjno-2023-000563f01.jpg
case_images: PMC10806776_01_bmjno-2023-000563f01.jpg
case_images: F1
case_images: Video head impulse testing (vHIT) was consistent with left peripheral vestibular hypofunction (figure 1), and pure tone audiometry confirmed a profound left-sided sensorineural hearing loss. An MRI brain and IAC after 7 days demonstrated increased signal of the left cochlea and semicircular canals on T1 and 3D fluid-attenuated inversion recovery (FLAIR) sequences, with no contrast enhancement (figure 1).