Nishizawa S, Yokoyama T, Uemura K, Ryu H, Ninchoji T, Shimoyama I, Shizume K, Sugiura Y, Sakai N, Nozue M
Neurol Med Chir (Tokyo). 1989 Aug;29(8):772-6. doi: 10.2176/nmc.29.772.
A 49-year-old female with no history of hearing disturbance developed sudden onset of headache and was admitted with no neurological deficits other than mild nuchal rigidity. Computed tomography (CT) showed subarachnoid hemorrhage. Four-vessel cerebral angiography disclosed no aneurysm. A second angiogram obtained on the 14th day showed vasospasm of the bilateral posterior cerebral arteries and right anterior inferior cerebellar artery, but still failed to demonstrate an aneurysm. Following the second angiography, she developed mild disturbance of consciousness and cerebellar ataxia of the right limbs, and repeat CT showed an infarct in the right cerebellar hemisphere. When she regained consciousness a few days later, she was completely deaf on the right side. The third angiography revealed a right vertebral artery dissecting aneurysm. Following clipping of the proximal portion of the right vertebral artery, she did well and was discharged, although right cerebellar ataxia and deafness persisted. Neuro-otological evaluation, including pure-tone audiography, auditory brainstem responses, electrocochleography, and caloric testing, indicated that her deafness resulted from ischemia in the territory of the right internal auditory artery due to vasospasm.
一名49岁女性，既往无听力障碍病史，突发头痛入院，除轻度颈部强直外无其他神经功能缺损。计算机断层扫描（CT）显示蛛网膜下腔出血。四血管脑动脉造影未发现动脉瘤。第14天进行的第二次血管造影显示双侧大脑后动脉和右侧小脑前下动脉血管痉挛，但仍未发现动脉瘤。第二次血管造影后，她出现轻度意识障碍和右侧肢体小脑性共济失调，复查CT显示右侧小脑半球梗死。几天后她恢复意识时，右侧完全失聪。第三次血管造影显示右侧椎动脉夹层动脉瘤。在夹闭右侧椎动脉近端后，她恢复良好并出院，尽管右侧小脑性共济失调和失聪仍然存在。包括纯音听力测定、听觉脑干反应、耳蜗电图和冷热试验在内的神经耳科学评估表明，她的失聪是由于血管痉挛导致右侧内听动脉供血区缺血所致。
