Asakuno Keizoh, Ishida Atsushi
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
Surg Neurol Int. 2014 May 6;5:61. doi: 10.4103/2152-7806.132031. eCollection 2014.
Cortical deafness is a rare symptom that is associated with bilateral lesions of the auditory cortex. To date, cortical deafness has been reported in only three cases of subarachnoid hemorrhage (SAH).
This 55-year-old female was admitted to our hospital with SAH caused by a ruptured left internal carotid artery (ICA) paraclinoid aneurysm. Computed tomography (CT) scans showed diffuse thick SAH with no other lesions such as an old infarction or hemorrhage. Emergent stent-assisted coil embolization was performed successfully and subsequent cisternal irrigation with urokinase almost completely washed out the thick SAH. During follow-up, she was alert and without any neurological deficits, however, she developed acute bilateral deafness on day 7 even though she had no history of hearing impairment. Because of the deafness, verbal communication was difficult. She became almost completely unable to hear and communication was confined to writing. Immediate diffusion-weighted (DW) image showed high intensities in bilateral superior temporal gyri due to severe vasospasm of bilateral middle cerebral arteries (MCAs). Immediate angiography showed severe vasospasm especially right MCA. A microcatheter was advanced to the right M1 and papaverine was administered. Soon after that, her hearing impairment dramatically improved. Our simple audiometry showed a hearing threshold average for both 1000 and 4000 Hz at 25 dB in both ears. She was discharged without any deficits in 2 weeks.
To our knowledge, this is the first reported case of pure cortical deafness due to bilateral vasospasm, which was immediately resolved by intraarterial administration of papaverine.
皮质性聋是一种罕见症状，与听觉皮层的双侧病变有关。迄今为止，仅在3例蛛网膜下腔出血（SAH）病例中报道过皮质性聋。
这名55岁女性因左侧颈内动脉（ICA）床突旁动脉瘤破裂导致的SAH入住我院。计算机断层扫描（CT）显示弥漫性厚层SAH，无其他病变，如陈旧性梗死或出血。成功进行了急诊支架辅助弹簧圈栓塞，随后用尿激酶进行脑池冲洗，几乎完全清除了厚层SAH。在随访期间，她神志清醒，无任何神经功能缺损，然而，尽管她没有听力障碍病史，但在第7天出现了急性双侧耳聋。由于耳聋，言语交流困难。她几乎完全无法听见，交流仅限于书写。即时弥散加权（DW）图像显示双侧颞上回高强度信号，原因是双侧大脑中动脉（MCA）严重血管痉挛。即时血管造影显示严重血管痉挛，尤其是右侧MCA。将微导管推进至右侧M1并给予罂粟碱。此后不久，她的听力障碍显著改善。我们的简易听力测试显示双耳在1000Hz和4000Hz的平均听力阈值均为25dB。她在2周后无任何缺损出院。
据我们所知，这是首例因双侧血管痉挛导致的纯皮质性聋的报道病例，通过动脉内给予罂粟碱立即得到解决。
