Arai M, Ishida N
Department of Neurology, Seirei Mikatahara General Hospital.
Rinsho Shinkeigaku. 2000 Aug;40(8):844-7.
We report a case of sudden bilateral hearing loss associated with an occlusion of the right vertebral artery. A 66-year-old man was admitted to hospital suffering from sudden onset vertigo, deafness, and vomiting. He could not walk due to truncal ataxia. There was positional nystagmus to the right; spontaneous and gaze-evoked nystagmus were absent. He had no facial nerve palsy, dysarthria, pyramidal tract signs, limb ataxia, and sensory impairment. Pure tone audiometry demonstrated a profound sensorineural deafness of both ears. A tentative diagnosis of sudden deafness was made. He was treated with intravenous infusion of corticosteroid; hearing loss of the left ear slightly improved. Cranial MR imaging demonstrated fresh small infarcts in the right cerebellar tonsil, the left cerebellar medulla, and the left middle cerebellar peduncle. MR angiography demonstrated an occlusion of the right vertebral artery. It is possible that reduced perfusion of the anterior inferior cerebellar arteries and internal auditory arteries on both sides resulted in multiple "border zone" infarcts and damage to the inner ear. Clinicians should be aware of the possibility of vertebrobasilar occlusive disease in case of sudden bilateral hearing impairment, even when brainstem or cerebellar signs are absent.
我们报告一例与右椎动脉闭塞相关的突发性双侧听力损失病例。一名66岁男性因突发眩晕、耳聋和呕吐入院。由于躯干共济失调，他无法行走。存在向右的位置性眼球震颤；无自发性和凝视诱发的眼球震颤。他没有面神经麻痹、构音障碍、锥体束征、肢体共济失调和感觉障碍。纯音听力测定显示双耳严重感音神经性耳聋。初步诊断为突发性耳聋。给予静脉输注皮质类固醇治疗；左耳听力损失略有改善。头颅磁共振成像显示右小脑扁桃体、左小脑延髓和左小脑脚有新鲜小梗死灶。磁共振血管造影显示右椎动脉闭塞。双侧小脑前下动脉和内听动脉灌注减少可能导致多处“边缘带”梗死和内耳损伤。临床医生在遇到突发性双侧听力障碍时，即使没有脑干或小脑体征，也应意识到椎基底动脉闭塞性疾病的可能性。
