Introduction: Empty sella (ES) is characterized by herniation of the subarachnoid space into the sella turcica, leading to pituitary flattening. Although often considered incidental, ES is increasingly recognized as a radiological marker of idiopathic intracranial hypertension (IIH) which classically presents with headache and visual loss. Importantly, IIH may also present with otolaryngological manifestations such as pulsatile tinnitus, hearing loss, and vertigo. Audiovestibular symptoms have been reported in up to 88.9% of patients with primary ES, with sensorineural hearing loss being the most frequent, while pulsatile tinnitus occurs in approximately 58% of IIH cases. Case: A 51-year-old female presented with 3 months of progressively worsening headaches, rapid deterioration of left-sided hearing, and a 20-kg weight gain over 1 year. Audiometry confirmed moderate left sensorineural hearing loss. Examination revealed a normotensive female with a body mass index of 35 kg/m² and diplopia on left upward gaze without evidence of ophthalmoplegia. The rest of the neurological examination was unremarkable. There was no evidence of papilledema or Cushingoid features. Repeat magnetic resonance imaging brain in 2025 showed persistent partial ES and loss of the posterior pituitary bright spot without an intracranial mass lesion or venous sinus thrombosis. There was no biochemical evidence of hypopituitarism or Cushing’s syndrome. Autoimmune markers were unremarkable. Lumbar puncture demonstrated a mildly elevated opening pressure of 23 mmHg with normal CSF composition. Based on the clinical and radiological findings, early IIH was diagnosed. She was treated with acetazolamide, and prescribed tirzepatide for weight reduction, resulting in improvement in headache and tinnitus. Conclusion IIH can manifest with partial ES and audiovestibular symptoms related to raised intracranial pressure. Early recognition is important, and IIH should be suspected in patients with pulsatile tinnitus or progressive sensorineural hearing loss. Acetazolamide and weight management remain the mainstay of treatment, with emerging evidence supporting a potential role for glucagon-like peptide-1 receptor agonists in reducing intracranial pressure.
Pseudotumor Cerebri ; Tinnitus ; Hearing Loss

Background: and Purpose Myasthenia gravis (MG) is clinically heterogeneous and can be classified into subgroups according to the clinical presentation, antibody status, age at onset, and thymic abnormalities. This study aimed to determine the clinical characteristics and outcomes of generalized MG (GMG) patients based on these subgroups. Methods: Medical records of MG patients from 1976 to 2023 were reviewed retrospectively.Patients with pure ocular MG were excluded. Data on demographic, clinical characteristics, laboratory features, and outcomes were analyzed. Results: This study included 120 GMG patients. There was a slight preponderance of female patients over male patients (male:female ratio=1:1.3), with the age at onset exhibiting a bimodal distribution. Female patients peaked at a lower age (21–30 years) whereas male patients peaked at a higher age (61–70 years). Most (92%, 105 of 114) patients had positive anti-acetylcholine receptor antibodies. Five patients were also tested for anti-muscle-specific tyrosine kinase antibodies, with two showing positivity. Thymectomy was performed in 62 (52%) patients, of which 30 had thymoma, 16 had thymic hyperplasia, 7 had an involuted thymus, and 6 had a normal thymus. There were significantly more female patients (68% vs. 45%, p=0.011) with early-onset disease (<50 years old) and thymic hyperplasia (33% vs. 0%, p<0.025). Most (71%) of the patients had a good outcome based on the Myasthenia Gravis Foundation of America postintervention status. GMG patients with early-onset disease had a significantly better outcome than patients with a late onset in univariate (58% vs. 37%, p=0.041) and multivariate (odds ratio=4.68, 95% confidence interval=1.17–18.64, p=0.029) analyses. Conclusions Female patients with early-onset MG and thymic hyperplasia had significantly better outcomes, but only early-onset disease was independently associated with a good outcome. These findings are comparable with those of other studies.