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A 53-YEAR-OLD man presented for evaluation of hearing loss, worsening balance, and decreased sense of smell. He complained of a progressive hearing loss over several years, with significantly more deterioration on the left side over the past several months. He noted that over the past 2 years, he had become more clumsy and had been unable to walk long distances without veering off to one side. He also noted that his sense of smell had decreased so much over the past 3 years that he had become unable to smell anything. His medical history was significant for severe head and neck injuries, along with multiple right cervical root avulsions, which he had suffered in a motorcycle crash 26 years earlier. He was left with a useless anesthetic right arm and opted for amputation of his right arm 1 year later. Physical examination revealed anosmia, a wide-based gait, and mild ataxia with tandem walking. Audiometric testing revealed an asymmetrical sensorineural hearing loss with decreased discrimination on the left. Because of the asymmetrical hearing loss and anosmia, contrast-enhanced magnetic resonance imaging (MRI) of the brain was performed (Figure 1, Figure 2, and Figure 3). Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload What is your diagnosis?
Archives of Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Jun 1, 2001
Keywords: amputation,anosmia,ataxia,physical examination,anesthetics,audiometry,sensorineural hearing loss,hearing tests,magnetic resonance imaging,medical history,avulsion fracture,hyposmia,head and neck injuries,hearing loss,avulsed wound,gait,arm,brain,smell perception,motorcycles
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