Koyama Tetsuo, Domen Kazuhisa
Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan.
Department of Rehabilitation Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Prog Rehabil Med. 2016 Jul 15;1:20160003. doi: 10.2490/prm.20160003. eCollection 2016.
Magnetic resonance diffusion-tensor imaging (DTI) is a tool for the assessment of neural fiber integrity. We applied DTI in a patient with hearing loss that developed after bilateral putaminal hemorrhage.
A 59-year-old woman was referred to our outpatient clinic for sequelae diagnosis. Six years earlier, she had suffered a left putaminal hemorrhage, but almost fully recovered. Four years later, she suffered a right putaminal hemorrhage, resulting in severe left hemiparesis and hearing loss. After receiving conservative acute care treatment, she was transferred to a long-term rehabilitation facility and returned home 7 months later, when her Functional Independence Measure score was 103 points. Although the patient could not respond to auditory stimuli, her writing and reading abilities were intact. Auditory examinations indicated that the brainstem response was normal, but pure tone audiometry was at the low end of the scale (105 dB). We examined the patient's brain using DTI, and the lesions were assessed in reference to the standard brain map transformed into her individual brain space. Fractional anisotropy and color brain maps indicated that the lesions were located within bilateral acoustic radiations. In addition, we applied fiber tracking analysis in which voxels of the medial geniculate bodies in the standard brain map were transformed into the patient's individual brain space and then taken as seeds for the fiber tracking. The resulting image showed bilateral disruption of acoustic radiation fibers.
By applying DTI, we identified the neuroanatomical pathology of hearing loss that developed after bilateral putaminal hemorrhage.
磁共振扩散张量成像（DTI）是一种评估神经纤维完整性的工具。我们将DTI应用于一名双侧壳核出血后出现听力丧失的患者。
一名59岁女性因后遗症诊断被转诊至我们的门诊。六年前，她曾发生左侧壳核出血，但几乎完全康复。四年后，她发生右侧壳核出血，导致严重的左侧偏瘫和听力丧失。接受保守的急性护理治疗后，她被转至长期康复机构，并于7个月后回家，当时她的功能独立性测量得分为103分。尽管患者对听觉刺激无反应，但其书写和阅读能力完好。听觉检查表明脑干反应正常，但纯音听力测定处于量表低端（105分贝）。我们使用DTI检查了患者的大脑，并参照转换为其个体脑空间的标准脑图谱评估病变。分数各向异性和彩色脑图谱表明病变位于双侧听辐射内。此外，我们应用纤维追踪分析，将标准脑图谱中内侧膝状体的体素转换为患者的个体脑空间，然后将其作为纤维追踪的种子点。所得图像显示双侧听辐射纤维中断。
通过应用DTI，我们确定了双侧壳核出血后出现的听力丧失的神经解剖病理学特征。
