Document Detail


Reversible cortical auditory dysfunction caused by cerebral vasospasm after ruptured aneurysmal subarachnoid hemorrhage and evaluated by perfusion magnetic resonance imaging. Case report.
MedLine Citation:
PMID:  17639887     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A 52-year-old woman developed subarachnoid hemorrhage (SAH) caused by a ruptured right internal carotid artery (ICA) aneurysm. Because of the aneurysm configuration, the authors decided to delay surgery and instead undertook serial imaging studies of the aneurysm. The patient remained alert but developed acute bilateral deafness on Day 7. Audiological examination and auditory brainstem responses suggested that the hearing disturbance was cortical in origin. Three-dimensional computed tomography (CT) angiography showed severe vasospasm in the right middle cerebral artery (MCA) and moderate vasospasm in the left ICA and MCA. Three-tesla magnetic resonance (MR) imaging was performed 2 days after the onset of symptoms. Diffusion-weighted and T2-weighted MR images showed an acute infarction in the right insular cortex caused by vasospasm. Perfusion-weighted MR imaging, particularly mean transit time mapping, revealed hypoperfusion in both temporal lobes including the auditory cortex and right auditory radiation. The vasospasm was treated with induction of mild hypertension and hypervolemia. Follow-up MR images, 3D CT angiograms, and audiometry performed 2 weeks after the first examination showed recovery of vasospasm and resolution of perfusion abnormality and hearing disturbance. On Day 26, the aneurysm was successfully occluded with clips and the patient was discharged with no deficits. To the authors' knowledge, this is the first reported case of reversible cortical auditory dysfunction purely due to bilateral cerebral vasospasm detected using perfusion MR imaging after SAH.
Authors:
Sadaharu Tabuchi; Mitsutoshi Kadowaki; Takashi Watanabe
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  107     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-20     Completed Date:  2007-08-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  161-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Institute of Neurological Sciences, Tottori University School of Medicine, Yonago, Japan. stabuchi@grape.med.tottori-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, Ruptured / complications*,  diagnosis,  pathology
Audiometry, Pure-Tone
Cerebral Cortex / pathology*,  physiopathology*
Female
Hearing Loss, Central / diagnosis,  etiology*,  physiopathology*
Humans
Imaging, Three-Dimensional
Intracranial Aneurysm / complications*,  diagnosis,  pathology
Magnetic Resonance Angiography / methods*
Middle Aged
Severity of Illness Index
Subarachnoid Hemorrhage / complications*,  diagnosis,  pathology
Tomography, X-Ray Computed
Vasospasm, Intracranial / complications*,  diagnosis,  pathology

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