43yr woman noticed few month ago when she listened to the music with earphones that it didn’t sound the same at both sides, she haired worse at the left. In her family hearing problems has father, uncle and aunt. She hasn’t have any balance problems.
She has gaze evoked nystagmus at both sides (Brun’s nystagmus), and torsional up-beat when fixating up-target.
Reduced VOR gain to the left and 50% paresis of the left labyrinth at caloric test.
Slight dysdiadochokinesia with left hand and finger-to-nose slight dysmetria with first try.
VNG shows saccadic smooth pursuit to the left.
MRI shows big CPA tumor 28x27x35mm
– ipsilesional, large amplitude low frequency, because of geze impairment
– contralesional, small amplitude high frequency, because of vestibular impalance