Cogan's syndrome is a disease of difficult diagnosis as there is no specific laboratorial exam and the same occurs with Vestibular Neurinitis. The clinical features of Cogan's syndrome are nonsyphilitic interstitial keratitis and vestibuloauditory dysfunction. Evidences of systemic vasculitis are found in 50% of the patients. The atypical forms of Cogan's syndrome array more severe inflammatory ocular disease. The clinical features of the Vestibular Neuronitis are acute episodes of vertigo that doesn't respond to clinical treatment. We exemplify these diagnostical difficulties with the case study of a patient who initiated a state of acute episodes of vertigo associated with fever and unilateral ocular pain. The patient was hospitalized, and initiated therapy for vestibular symptoms, not responding to medications. A week later, the patient evoluted to an ocular disease characterized by anterior sclerouveitis. With fifteen days of evolution, the patient presented a state of rapidly progressive hearing loss. The otoneurological exam showed unilateral diminished caloric response. Magnetic resonance imaging showed signs of microvasculitis in the central nervous system, being diagnosed Cogan's syndrome. Therapy was initiated with oral prednisone and cyclophosphamide, with total improvement of vertigo, dizziness and eye symptoms and partial improvement of sensorineural hearing loss.
Cogan's syndrome; vestibular neuronitis; vertigo
