Yuan Ziyun, Xiang Lei, Liu Ran, Yue Wei
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
Front Med (Lausanne). 2023 May 5;10:1174512. doi: 10.3389/fmed.2023.1174512. eCollection 2023.
The middle cerebellar peduncle (MCP) is the most common site associated with hearing impairment in acute ischaemic stroke. Narrowing or occlusion of the vertebrobasilar artery due to atherosclerosis is thought to be the main pathogenesis of MCP infarction. Most previous reports of MCP infarction have not been clear whether the patient's hearing impairment is localized to the center or periphery.
We report 44-year-old man with vertigo, tinnitus, and bilateral sudden sensorineural hearing loss (SSNHL) as the first symptoms. Pure Tone Audiogram revealed complete hearing loss in both ears. Acute bilateral MCP infarction was diagnosed by repeated brain magnetic resonance imaging (MRI). The brainstem auditory evoked potential (BAEP) and the electrocochleography were normal. The otoacoustic emissions showed binaural cochlear dysfunctions. After the antiplatelet, lipid-lowering, steroids and hyperbaric oxygen therapy, the pure-tone average (PTA) showed a clear improvement with 67 decibels (dB) on the right and 73 dB on the left at the 3-month follow-up.
Vertebrobasilar diseases due to atherosclerosis should be routinely considered in middle-aged and elderly patients with vascular risk factors and bilateral hearing loss. Bilateral SSNHL can be a prodrome of acute MCP infarction and it can be peripheral. Brain MRI, brain magnetic resonance angiogram (MRA), brain and neck computed tomography angiography (CTA), BAEP, otoacoustic emissions, and Pure Tone Audiogram help to localize and qualify the diagnosis. Bilateral SSNHL localized to the periphery usually improves better and has a good prognosis. Early detection of hearing loss and intervention can help patients recover.
小脑中脚（MCP）是急性缺血性卒中所致听力障碍最常见的相关部位。动脉粥样硬化导致的椎基底动脉狭窄或闭塞被认为是MCP梗死的主要发病机制。既往大多数关于MCP梗死的报道并未明确患者的听力障碍是局限于中枢还是外周。
我们报告一名44岁男性，以眩晕、耳鸣和双侧突发性感音神经性听力损失（SSNHL）为首发症状。纯音听力图显示双耳完全听力丧失。通过重复脑磁共振成像（MRI）诊断为急性双侧MCP梗死。脑干听觉诱发电位（BAEP）和耳蜗电图正常。耳声发射显示双耳耳蜗功能障碍。经过抗血小板、降脂、类固醇和高压氧治疗后，在3个月的随访中，纯音平均听阈（PTA）有明显改善，右侧为67分贝（dB），左侧为73 dB。
对于有血管危险因素和双侧听力损失的中老年患者，应常规考虑动脉粥样硬化所致的椎基底动脉疾病。双侧SSNHL可能是急性MCP梗死的前驱症状，且可能是外周性的。脑MRI、脑磁共振血管造影（MRA）、脑和颈部计算机断层血管造影（CTA）、BAEP、耳声发射和纯音听力图有助于定位和明确诊断。局限于外周的双侧SSNHL通常改善更好，预后良好。早期发现听力损失并进行干预有助于患者康复。
