Arakaki Yoshito, Yoshimoto Takeshi, Ishiyama Hiroyuki, Tanaka Tomotaka, Hattori Yorito, Ihara Masafumi
Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
eNeurologicalSci. 2022 Oct 27;29:100431. doi: 10.1016/j.ensci.2022.100431. eCollection 2022 Dec.
Intracerebral hemorrhage with sudden hearing loss as the initial symptom is rare. A right-handed man with a history of right putaminal hemorrhage developed near-complete hearing loss and right hemiplegia and was taken to our hospital by ambulance. Non-contrast computed tomography demonstrated acute intracerebral hemorrhage in the left putamen. A region of old right putaminal hemorrhage involving the right temporal stem was also shown on fluid-attenuated inversion recovery. Standard pure-tone audiometry showed right-dominant bilateral sensorineural hearing loss. More than 2 months after onset, the bilateral sensorineural hearing loss gradually improved without interfering with daily life. Detailed history-taking indicated that the old hemorrhage in the right putamen 12 years previously had caused sudden left-dominant bilateral hearing impairment due to asymmetric but bilateral innervation from the auditory nerve. The bilateral damage to the temporal stem involving acoustic radiation resulted in temporary near-complete hearing loss after the recurrence, but the amelioration of edema in the left temporal stem may have resulted in partial recovery of the hearing loss. This patient's clinical progression suggests that the auditory tract ascends mainly on the side opposite the ear and may explain the left dominance in the level of acoustic radiation.
以突然听力丧失为首发症状的脑出血较为罕见。一名有右侧壳核出血病史的右利手男性出现了近乎完全的听力丧失和右侧偏瘫，随后被救护车送往我院。非增强计算机断层扫描显示左侧壳核急性脑出血。液体衰减反转恢复序列成像还显示右侧壳核有陈旧性出血，累及右侧颞叶干。标准纯音听力测定显示以右侧为主的双侧感音神经性听力损失。发病2个多月后，双侧感音神经性听力损失逐渐改善，未影响日常生活。详细的病史询问表明，12年前右侧壳核的陈旧性出血由于来自听神经的不对称但双侧的神经支配，导致了以左侧为主的双侧突然听力障碍。双侧颞叶干损伤累及听觉辐射，导致复发后出现暂时的近乎完全听力丧失，但左侧颞叶干水肿的改善可能导致了听力损失的部分恢复。该患者的临床病程提示，听觉通路主要在对侧耳侧上行，这可能解释了听觉辐射水平上的左侧优势。
