warfarin and Hearing-Loss--Sensorineural

We present a case of systemic lupus erythematosus with symptomatic sensorineural hearing loss which was successfully treated with azathioprine, as assessed both clinically and radiologically. We also present a review of the relevant literature.. A woman with systemic lupus erythematosus presented with sensorineural hearing loss, initially on the right and subsequently developing on the left over several months. An audiogram revealed profound neurosensory hearing loss bilaterally. The patient was treated with prednisone 60 mg daily and azathioprine 200 mg daily. An improvement on the left was noted on follow-up audiography as well as on magnetic resonance imaging of the internal auditory canals and surrounding structures.. Sensorineural hearing loss has been described in autoimmune disorders but is rare. Aural symptoms have been described, with varying incidences (0-57.5 per cent), in systemic lupus erythematosus. However, symptomatic sensorineural hearing loss is rare in systemic lupus erythematosus. Prednisone appears essential when an immunological or vasculitic cause is found. The use of azathioprine should be considered, as well as follow-up with magnetic resonance imaging to detect improvement.

Topics: Adult; Anticoagulants; Antimetabolites; Audiometry, Pure-Tone; Azathioprine; Drug Therapy, Combination; Female; Hearing Loss, Sensorineural; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Nystagmus, Pathologic; Prednisone; Treatment Outcome; Warfarin

The antiphospholipid syndrome is the association between the presence of antiphospholipid antibodies, thrombosis and/or pregnancy morbidity and mortality. This report presents two cases of antiphospholipid antibodies and sensorineural hearing loss and discusses the probable causative link. We recommend that patients presenting with sudden sensorineural hearing loss are investigated for evidence of antiphospholipid antibodies. Life long anticoagulation is necessary to prevent life threatening thrombotic or thromboembolic events.

Topics: Anticoagulants; Antiphospholipid Syndrome; Dizziness; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Hearing Loss, Unilateral; Humans; Lupus Coagulation Inhibitor; Male; Middle Aged; Thrombophilia; Thrombosis; Vertigo; Warfarin

Topics: Abortion, Induced; Adult; Antibodies, Anticardiolipin; Anticoagulants; Antiphospholipid Syndrome; Cholecystectomy; Cholecystitis; Female; Fetal Death; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Heparin, Low-Molecular-Weight; Humans; Pregnancy; Pregnancy Trimester, Second; Tinnitus; Treatment Outcome; Warfarin

Elderly patients with balance problems are at high risk for falls. When these same patients are also on anticoagulants, the consequences of a fall can be serious. Anticoagulant therapy increases the risk of cerebral hemorrhage. Even mild head trauma can cause a fatal cerebral hemorrhage when anticoagulants are used. However, this risk needs to be weighed against the possibility of spontaneous stroke. The decision to choose anticoagulant therapy can become even more complicated if the patient has an increased risk of falling. A case is presented of an 87-year-old female with balance problems, in part from a small unilateral vestibular schwannoma. She was also receiving Coumadin anticoagulant therapy. When she began to fall, a decision had to be made about the relative risks and benefits of Coumadin therapy. The risk/benefit calculation could change, however, depending on whether her fall risk could be improved. This article presents the diagnostic test results and medical opinions surrounding this case. The importance of assessing patients' overall situation is stressed in planning rehabilitation.

Topics: Accidental Falls; Aged, 80 and over; Anticoagulants; Female; Hearing Loss, Sensorineural; Humans; Magnetic Resonance Imaging; Neuroma, Acoustic; Postural Balance; Recurrence; Warfarin