Yaguchi H, Yaguchi M, Nishiwaki C, Takahashi Y
Department of Neurology, Tachikawa Medical Center, YuYukenkoumura Hospital, Niigata, Japan.
No To Shinkei. 2000 Mar;52(3):249-52.
The study case was a 66-year-old man who had bilateral neurosensory hearing impairment due to brain stem infarctions. He noticed mild hearing loss, frequent vertigo and tinnitus. About one month later, his hearing took a sudden turn for the worse, and he suffered from dysarthria, dysphagea and abasia. Neurological examination revealed pseudobulber palsy, left hemiparesis, cerebeller ataxia, disturbance of pain and temperature sensation on the right face and left side of the body. Brain stem auditory evoked potentials (BAEPs) showed a delayed small wave V with the abscence of previous waves on the right side and no significant waves on the left side. Brain magnetic resonance images (MRI) revealed infarctions in the bilateral middle cerebellar peduncles, including in the right lateral portions of pons, and the right lower pontine base. We believe that not only peripheral, but also central auditory pathways adjacent to infarctions were damaged. Magnetic resonance angiography (MRA) showed severe stenosis or occlusion of left vertebral artery and basilar artery. We concluded that hypoperfusion of the vertebrobasilar artery territories caused ischemia of the cochlear nerve and the auditory tracts in the brain stem, which resulted in bilateral hearing loss.
该病例为一名66岁男性，因脑干梗死导致双侧神经性听力障碍。他出现轻度听力损失、频繁眩晕和耳鸣。约一个月后，其听力突然恶化，并出现构音障碍、吞咽困难和步行不能。神经系统检查发现假性球麻痹、左侧偏瘫、小脑性共济失调、右侧面部和左侧身体痛温觉障碍。脑干听觉诱发电位（BAEP）显示右侧V波延迟且小波幅，之前的波消失，左侧无明显波。脑磁共振成像（MRI）显示双侧小脑中脚梗死，包括脑桥右侧外侧部分及右侧脑桥下部基底。我们认为，不仅梗死灶周围的外周听觉通路，而且中枢听觉通路也受到了损害。磁共振血管造影（MRA）显示左侧椎动脉和基底动脉严重狭窄或闭塞。我们得出结论，椎基底动脉供血区灌注不足导致耳蜗神经和脑干听觉传导束缺血，进而引起双侧听力损失。
