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Destructive, granulating lesion in the temporal bone after elevated plasma homocysteine
Per Bonding1, Elisabeth Skriver, Pekka Helin
1Department of Otolaryngology, Glostrup University Hospital, Denmark. pebo@gentoftehosp.kbhamt.dk
Summary
A case of sudden deafness in a man was linked to high homocysteine levels, a risk factor for blood clots. Treatment with folic acid resolved the temporal bone lesion, suggesting a thromboembolic cause for this otolaryngologic condition.
Area of Science:
- Otolaryngology
- Neurology
- Hematology
Background:
- Sudden sensorineural hearing loss and vertigo can present with varied etiologies.
- Avascular osteonecrosis is a known condition, often associated with risk factors for thrombosis.
- Hyperhomocysteinemia is an independent risk factor for thromboembolic events.
Observation:
- A 38-year-old man presented with sudden left-sided deafness, vertigo, and temporary facial palsy.
- A destructive lesion in the left temporal bone was initially diagnosed as granulation tissue.
- The patient later developed a pulmonary embolism, revealing significantly elevated plasma homocysteine levels.
Findings:
- Elevated homocysteine levels, a risk factor for thromboembolic lesions, were identified.
- Treatment with folic acid normalized homocysteine levels and led to the resolution of the temporal bone lesion.
- The case suggests a thromboembolic etiology, likely affecting the labyrinthine artery, leading to avascular osteonecrosis in the temporal bone.
Implications:
- This case highlights a potential, previously unreported association between hyperhomocysteinemia and temporal bone lesions.
- Early identification and management of hyperhomocysteinemia may be crucial in preventing or treating similar otolaryngologic thromboembolic events.
- Further research is warranted to explore the link between metabolic factors and vascular compromise in the temporal bone.