Perisaccular vascular obstruction during an acute attack of Meniere’s disease.

OBJECTIVE: To shed some light on the morphological findings underlying the occurrence of Meniere's attack. MATERIALS AND METHODS: An endolymphatic sac sample was taken during ablation surgery from a patient who was experiencing a disabling stage with recurrent vertigo attacks from Meniere's disease. The sample consisted of the most proximal extraosseous portion of the ES, including both walls. The specimen was sent to Transmission Electron microscopic examination and the analysis was in particular focused on the subepithelial region. RESULTS: No evidence of epithelial damage was observed, and the sample showed signs of high metabolic activity in all cellular components. The most striking findings were found at the. level of the subepithelial space, where diffuse signs of vascular thrombosis were identified. The intravascular occlusion was variously represented. by sludged erythrocytes and an amorphous, lipid-like,material. CONCLUSION: The occlusion of perisaccular vessels might be regarded as a pathognomonic finding, concurring to the manifestation of acute Meniere's disease.