Department of Neurosurgery, Tokushima Municipal Hospital, 2-34, Kitajyosanjima-cho, Tokushima, 770-0812, Japan.
Department of Otolaryngology, Takamatsu Red Cross Hospital, Kagawa, Japan.
J Med Case Rep. 2021 Mar 2;15(1):111. doi: 10.1186/s13256-020-02574-8.
Most sudden-onset hearing loss is due to otolaryngologic- and very rarely to cerebrovascular disease. We report a woman with sudden bilateral sensorineural hearing loss. This case suggests that even in the absence of brainstem or cerebellar signs, magnetic resonance imaging (MRI) and MR angiography (MRA) should be performed since such studies may reveal signs of life-threatening vertebrobasilar artery occlusion.
A 73-year-old Japanese woman with a history of hypertension, hyperlipidemia, and atrial fibrillation who suffered bilateral deafness with vertigo and vomiting was transferred from a local hospital to our department. On admission her consciousness was clear and vertigo was absent. Neurological examination revealed only bilateral sensorineural hearing loss. Head computed tomography (CT) returned no significant findings. The next morning she gradually developed severe drowsiness. Diffusion-weighted MRI demonstrated acute cerebral infarction in the brainstem and bilateral cerebellum; MRA showed basilar artery occlusion due to a cardioembolic thrombus. Revascularization was obtained by endovascular treatment. However, her condition worsened progressively during the following hours. CT revealed new brainstem lesions, massive cerebellar swelling, and obstructive hydrocephalus. She died on the second day after her admission.
When hearing loss is due to vertebrobasilar occlusive disease, the prognosis is very poor. We suggest that vertebrobasilar stroke be suspected in patients with bilateral sensorineural hearing loss who present with risk factors for stroke such as atrial fibrillation and other neurologic signs.
大多数突发性听力损失是由耳鼻喉科疾病引起的，极少数情况下是由脑血管疾病引起的。我们报告了一例双侧突发性感觉神经性听力损失的女性患者。该病例提示，即使没有脑干或小脑体征，也应进行磁共振成像（MRI）和磁共振血管造影（MRA）检查，因为这些检查可能会发现危及生命的椎基底动脉闭塞的迹象。
一名 73 岁的日本女性，有高血压、高血脂和心房颤动病史，因双侧耳聋伴眩晕和呕吐而从当地医院转入我科。入院时，她意识清楚，无眩晕。神经系统检查仅发现双侧感觉神经性听力损失。头部计算机断层扫描（CT）无明显异常。第二天早上，她逐渐出现严重的嗜睡。弥散加权 MRI 显示脑干和双侧小脑急性脑梗死；MRA 显示基底动脉因心源性栓塞性血栓形成而闭塞。通过血管内治疗实现了再通。然而，在接下来的几个小时里，她的病情逐渐恶化。CT 显示新的脑干病变、大量小脑肿胀和梗阻性脑积水。她在入院后第二天死亡。
当听力损失是由于椎基底动脉闭塞性疾病引起时，预后非常差。我们建议，对于有房颤等卒中危险因素且伴有双侧感觉神经性听力损失和其他神经体征的患者，应怀疑椎基底动脉卒中。
