Hand ; Humans ; Pain

INTRODUCTIONRadiation injury resulting in sudden, late onset sensorineural hearing loss is a recognised complication in patients who have received head and neck irradiation. We describe the magnetic resonance imaging (MRI) of the internal acoustic canal (IAC) of 3 such patients and postulate a cause for these findings.

CLINICAL PICTUREA total of 63 patients were referred for MRI IAC for sudden-onset sensorineural hearing loss. Of these patients, only 5 patients had abnormal MRI finding in the affected ear and the remaining patients had normal studies. Two patients had acoustic neuromas. Three patients demonstrated high T1-weighted signal in the labyrinths of the affected ears and had past histories of head and neck irradiation. The MRI findings and medical records of these 3 patients were reviewed and described in this case series.

OUTCOMEHigh labyrinthine signal on unenhanced T1-weighted images in the symptomatic ear of these patients was observed, suggesting the possibility of haemorrhage. In the patient who had a history of brain tumour, susceptibility artifacts were also seen in the right hemipons on the gradient-echo images, indicating the presence of paramagnetic substances from previous therapy.

CONCLUSIONWe postulate that labyrinthine haemorrhage is a rare, late complication of head and neck irradiation, resulting in sudden sensorineural hearing loss.

Female ; Head and Neck Neoplasms ; radiotherapy ; Hearing Loss, Sensorineural ; etiology ; Hearing Loss, Sudden ; etiology ; Hemorrhage ; complications ; Humans ; Labyrinth Diseases ; complications ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiotherapy ; adverse effects ; Radiotherapy Dosage ; Time Factors

Livedoid vasculopathy is a rare chronic relapsing disorder characterised by recurrent painful thrombotic and vasculitic ulcers on the legs. We present the cases of two Indian women with livedoid vasculopathy that were found to be associated with an underlying factor V Leiden heterozygous mutation. There were no other thrombotic manifestations, and livedoid vasculopathy was the sole presenting feature of the factor V Leiden mutation, although this could also be coincidental. Initial treatment with high-dose immunosuppressive therapy was suboptimal, and the addition of pentoxifylline and antiplatelet therapy was crucial in achieving disease control and remission. These cases highlight the possible association with an underlying prothrombotic disorder, such as factor V Leiden mutation, in patients with livedoid vasculopathy. Although this association is relatively uncommon, it is more relevant to Indian patients, as the presence of factor V Leiden mutation is highest in this ethnicity as compared to the local Malay and Chinese populations.
Adult ; Blood Vessels ; pathology ; DNA ; genetics ; Factor V ; genetics ; metabolism ; Female ; Humans ; Leg Ulcer ; blood ; genetics ; pathology ; Livedo Reticularis ; blood ; diagnosis ; genetics ; Point Mutation ; Polymerase Chain Reaction ; Skin ; blood supply ; Skin Diseases, Vascular ; blood ; genetics ; pathology