Labyrinthine hemorrhage (LH) is a rare cause of sudden sensorineural hearing loss (SNHL) and acute vestibular syndrome (AVS), which may mimic both peripheral and central etiologies. We report a case of a 76-year-old male on edoxaban therapy presenting with sudden right-sided SNHL and vertigo. Brain magnetic resonance imaging (MRI) performed 2 weeks later showed T1 and fluid-attenuated inversion recovery (FLAIR) hyperintensity of the right inner ear, consistent with LH. Evaluation of AVS in the emergency setting remains challenging, as LH may present as a rare stroke mimic, often indistinguishable from isolated labyrinthine stroke or labyrinthitis. Proper application and interpretation of vestibular assessment protocols, such as HINTS-plus, are critical in such cases. When bedside vestibular testing suggests central-type findings, but initial neuroimaging is normal, high-resolution brain MRI focused on the inner ear might be essential to rule out LH. Awareness of this rare entity may help prevent misdiagnosis, inappropriate thrombolysis, and delayed recognition, although stroke management should still be prioritized when HINTS-plus suggests a central pattern. This case highlights the diagnostic complexity of AVS and its potential pitfalls in bedside and imaging assessment, raising awareness of LH as a rare but clinically relevant stroke mimic.

Acute myeloid leukemia (AML) with hyperleukocytosis is a hematologic emergency associated with high early mortality. Viral infections, including SARS-CoV-2, have been proposed as potential factors that may unmask previously undiagnosed leukemia or accelerate disease progression in predisposed individuals. We report the case of a previously healthy 61-year-old man who presented after recent travel with progressive fatigue, dizziness, fever, and multiple generalized seizures. Initial evaluation revealed COVID-19 infection with profound cytopenias and hyperleukocytosis, including a white blood cell (WBC) count of 132.9 × 10⁹/L, hemoglobin of 5.4 g/dL, and platelets of 11 × 10⁹/L. Peripheral smear demonstrated 36%-40% circulating myeloblasts with Auer rods, consistent with AML. Neuroimaging showed no intracranial hemorrhage. Laboratory evaluation revealed hyperuricemia, markedly elevated lactate dehydrogenase, hyperlactatemia (6.5 mmol/L), and acute kidney injury, concerning for early tumor lysis physiology. The patient was admitted to the intensive care unit and treated with hydroxyurea for cytoreduction, tumor lysis prophylaxis with allopurinol, transfusion support, and COVID-19-directed therapy. His leukocyte count decreased from 132.9 × 10⁹/L to 32.5 × 10⁹/L within 72 hours, with clinical stabilization. After initial cytoreduction and metabolic improvement, he was transferred to a tertiary oncology center for definitive induction therapy. This case raises the possibility that COVID-19-associated immune dysregulation may contribute to the clinical presentation of previously undiagnosed leukemia and underscores the importance of rapid cytoreduction, tumor lysis prevention, and multidisciplinary management in patients presenting with hyperleukocytic AML.

To introduce the application of acupuncture-based therapy in a patient with orthostatic hypotension after cervical spinal cord injury. The patient presented with flaccid paralysis of all four limbs, and could only maintain normal blood pressure in the supine position after cervical spine trauma surgery. Acupuncture combined with comprehensive training of paraplegic limbs and joint mobilization training was administered. Acupoints were divided into groups A and B, acupuncture was applied once daily, with the two groups alternated. Group A included Baihui (GV20) and bilateral Quchi (LI11), Neiguan (PC6), Hegu (LI4), and Taiyuan (LU9) in the patient's preserved sensory areas. Group B included bilateral Zusanli (ST36), Taixi (KI3), Taibai (SP3), and Taichong (LR3) in the patient's sensory-deficient areas. Blood pressure was monitored using an electric standing bed before and after acupuncture treatment. After 10 treatments, the patient was able to sit out of bed at 90° and use a wheelchair. At a 2-month follow-up, the patient was able to use a wheelchair at home and had no symptoms of orthostatic hypotension such as dizziness, transient visual darkening, or tinnitus.

Emerging evidence suggests that sensorineural hearing loss and tinnitus may share similar microvascular and cardiometabolic etiologies, yet the potential association between retinal vein occlusion (RVO) and audiovestibular disorders has not been fully elucidated. This retrospective observational study aimed to investigate whether patients with RVO have an increased prevalence of tinnitus, hearing loss, vertigo, and sudden deafness. We used data from the Longitudinal Health Insurance Database 2010 of Taiwan. Adults diagnosed with RVO were identified and compared to comparison patients without RVO using a 1:3 propensity score matching approach, aligning them based on sociodemographic characteristics and vascular comorbidities. Multivariable logistic regressions were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of tinnitus, hearing loss, vertigo, and sudden deafness between RVO group and comparison group. A total of 6,403 patients with RVO and 19,209 matched compariosn patients were included. Compared with compariosn group, RVO group had significantly higher prevalence of tinnitus (13.90% vs. 11.58%; p<.001) and hearing loss (10.15% vs. 8.39%; p<.001), but not vertigo or sudden deafness. After adjustment, RVO remained associated with increased odds of tinnitus (OR = 1.236; 95% CI 1.136-1.344) and hearing loss (OR = 1.240; 95% CI 1.125-1.366). We concluded that RVO group exhibit a higher prevalence of tinnitus and hearing loss compared with matched comparison group, supporting a possible shared microvascular or systemic vascular pathophysiology. Audiologic assessment may be considered in the comprehensive evaluation of individuals with RVO.