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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 4  |  Page : 469-470

Vasospasm causing reversible cortical deafness in subarachnoid hemorrhage


Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India

Date of Web Publication19-Sep-2014

Correspondence Address:
Raghvendra Ramdasi
Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra
India
Raghvendra Ramdasi
Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.141292

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How to cite this article:
Ramdasi R, Chagla A, Mahore A, Ramdasi R, Chagla A, Mahore A. Vasospasm causing reversible cortical deafness in subarachnoid hemorrhage . Neurol India 2014;62:469-70

How to cite this URL:
Ramdasi R, Chagla A, Mahore A, Ramdasi R, Chagla A, Mahore A. Vasospasm causing reversible cortical deafness in subarachnoid hemorrhage . Neurol India [serial online] 2014 [cited 2019 Dec 12];62:469-70. Available from: http://www.neurologyindia.com/text.asp?2014/62/4/469/141292


Sir,

A 32-year-old male presented with sudden onset of holocranial severe headache of 2-day duration. Magnetic resonance imaging (MRI) of brain showed subarachnoid hemorrhage (SAH) in the left sylvian fissure [Figure 1]a-d. Cerebral computed tomographic angiography (CTA) revealed an aneurysm at bifurcation of the left-middle cerebral artery [Figure 1]e. He was advised surgery but he did not turn up for five days due to some family issues. On the eighth day, he developed bilateral deafness of sudden onset. Pure tone audiometry (PTA) confirmed presence of bilateral sensorineural hearing loss [Figure 2]a. Brainstem auditory evoked potentials demonstrated normal patterns bilaterally. Transcranial doppler (TSD) showed elevated blood flow velocities (~280 cm/s) involving both middle cerebral arteries. Patient refused surgery in that hospital due to economic constraints and got admitted to our facility. Neurologic examination revealed bilateral sensorineural hearing loss. Patient had left pterional craniotomy and clipping of the aneurysm. Patient improved in sensorium and deafness after five days of surgery. Postoperative pure tone audiometry confirmed resolution of the sensorineural deafness [Figure 2]b. At follow-up of 12 months the patient is doing well.
Figure 1: T1 weighted axial image (a), FLAIR image (b), GRE sequence (c and d) of MRI showing blood in the left sylvain fissure. (e) CT angiography of brain showing aneurysm at bifurcation of left middle cerebral artery

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Figure 2: (a) Preoperative pure tone audiogram (PTA) of patient suggestive of bilateral sensorineural hearing loss. (b) Postoperative PTA of patient showing normal findings

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Severe auditory deficit due to bilateral cerebral lesions is called as "cortical deafness". In cortical deafness, auditory signals cannot be perceived in the cortex and audiometry reveals severe bilateral hearing loss. It results from damage to both temporal or temporoparietal lobes including the primary auditory cortex (Broadmann areas 41 and 42) on both transverse gyri (Heschl). The clinical syndrome of cortical deafness with bitemporal infarction was described by Wernicke and Friedlander in 1883. [1]

Different causes of cortical deafness include congenital lesions, cerebral infarction or cerebral hemorrhage. [1] We could find only four cases of cortical deafness caused by vasospasm in subarachnoid hemorrhage [Table 1]. Peripheral hearing loss due to aneurysmal bleed is most commonly caused by antero-inferior cerebellar artery (AICA) aneurysm [Table 2]. Rhoton divided AICA in to four segments - anterior pontine, lateral pontine, floculonodular, and cortical. The lateral pontine segment is divided into premeatal, meatal, and postmeatal parts. Mazzoni found the meatal segment was medial to porus in 33%, reaching the porus in 27% and entered the canal in 40%. All the AICA aneurysm causing deafness belong to the latter group. [4]

The MRI including diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) sequences are promising techniques to assess brain ischemia in SAH. Perfusion-weighted MRI is a useful new tool in the treatment of patients with SAH, particularly those with cerebral vasospasm, and the temporary neurological deficits correlate well with the location of perfusion changes. [1] We could not perform these investigations because of economic constraints on the part of the patient. However, the findings of TCD study in bilateral MCA territories suggest cerebral vasospasm as the possible cause for bilateral deafness in outpatient.
Table 1: Aneurysm causing central deafness

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Table 2: Aneurysm causing peripheral deafness

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All the cases of cortical deafness caused by vasospasm in SAH baring one report, which is reported by Ogane et al. improved after treatment of aneurysm and vasospasm. The one reported by Ogane et al. had old temporal infarction. [1],[2],[3] But peripheral deafness caused by intrameatal aneurysm was irreversible except that reported by Okumura et al.[4] SAH should be considered in the differential diagnosis of acute hearing loss.[7]

 
  References Top

1.Tabuchi S, Kadowaki M, Watanabe T. Reversible cortical auditory dysfunction caused by cerebral vasospasm after ruptured aneurysmal subarachnoid hemorrhage and evaluated by perfusion magnetic resonance imaging. Case report. J Neurosurg 2007;107:161-4.  Back to cited text no. 1
    
2.Maslehaty H, Doerner L, Barth H, Rohr A, Mehdorn HM. Reversible bilateral hypacusis after aneurysmal subarachnoid hemorrhage. Neuroradiology 2010;52:1057-9.  Back to cited text no. 2
    
3.Ponzetto E, Vinetti M, Grandin C, Duprez T, Van Pesch V, Deggouj N, et al. Partly reversible central auditory dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 2013;119:1125-8.  Back to cited text no. 3
    
4.Sun Y, Wrede KH, Chen Z, Bao Y, Ling F. Ruptured intrameatal AICA aneurysms--a report of two cases and review of the literature. Acta Neurochir (Wien) 2009;151:1525-30.  Back to cited text no. 4
    
5.Arnold W, Vosteen KH. Sudden deafness as a consequence of rupture of a basilar artery aneurysm (author's transl). HNO 1977;25:127-30.  Back to cited text no. 5
    
6.Conclasure JB, Graham SS. Intracranial aneurysm occurring as sensorineural hearing loss. Otolaryngol Head Neck Surg 1981;89:283-7.  Back to cited text no. 6
    
7.Nishizawa S, Yokoyama T, Uemura K, Ryu H, Ninchoji T, Shimoyama I, et al. Unilateral nerve deafness due to rupture of a right vertebral artery aneurysm. Case report. Neurol Med Chir (Tokyo) 1989;29:772-6.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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