- Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan
DOI:10.4103/2152-7806.132031Copyright: © 2014 Asakuno K This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Asakuno K, Ishida A. Intraarterial vasodilator therapy immediately rescued pure cortical deafness due to bilateral cerebral vasospasm. Surg Neurol Int 06-May-2014;5:61
How to cite this URL: Asakuno K, Ishida A. Intraarterial vasodilator therapy immediately rescued pure cortical deafness due to bilateral cerebral vasospasm. Surg Neurol Int 06-May-2014;5:61. Available from: http://sni.wpengine.com/surgicalint_articles/intraarterial-vasodilator-therapy-immediately-rescued-pure-cortical-deafness-due-to-bilateral-cerebral-vasospasm/
Background:Cortical deafness is a rare symptom that is associated with bilateral lesions of the auditory cortex. To date, cortical deafness has been reported in only three cases of subarachnoid hemorrhage (SAH).
Case Description:This 55-year-old female was admitted to our hospital with SAH caused by a ruptured left internal carotid artery (ICA) paraclinoid aneurysm. Computed tomography (CT) scans showed diffuse thick SAH with no other lesions such as an old infarction or hemorrhage. Emergent stent-assisted coil embolization was performed successfully and subsequent cisternal irrigation with urokinase almost completely washed out the thick SAH. During follow-up, she was alert and without any neurological deficits, however, she developed acute bilateral deafness on day 7 even though she had no history of hearing impairment. Because of the deafness, verbal communication was difficult. She became almost completely unable to hear and communication was confined to writing. Immediate diffusion-weighted (DW) image showed high intensities in bilateral superior temporal gyri due to severe vasospasm of bilateral middle cerebral arteries (MCAs). Immediate angiography showed severe vasospasm especially right MCA. A microcatheter was advanced to the right M1 and papaverine was administered. Soon after that, her hearing impairment dramatically improved. Our simple audiometry showed a hearing threshold average for both 1000 and 4000 Hz at 25 dB in both ears. She was discharged without any deficits in 2 weeks.
Conclusions:To our knowledge, this is the first reported case of pure cortical deafness due to bilateral vasospasm, which was immediately resolved by intraarterial administration of papaverine.
Keywords: Cerebral vasospasm, Cortical deafness, Intra-arterial papaverine
Posthemorrhagic cerebral vasospasm (PHCV) is a common problem and a significant cause of mortality and permanent disability following aneurysmal subarachnoid hemorrhage (SAH). While medical therapy remains the mainstay of prevention against PHCV and the first-line treatment for symptomatic patients, endovascular options should not be delayed in medically refractory cases.[
A 55-year-old right-handed female was admitted to the intensive care unit (ICU) for an SAH caused by the rupture of a left internal carotid artery (ICA) paraclinoid aneurysm [
In order to prevent vasospasm, she was treated with induction of mild hypertension and hypervolemia. Oral administration of cilostazol was also done for the purpose.[
Neuroimages obtained at the onset of deafness. (a) MR angiogram showing severe vasospasm in the right MCA and moderate vasospasm in the left MCA. (b) DW image showing high signal intensity at the right insular cortex and the left superior temporal gyrus, indicating acute infarction due to vasospasm. (c) ASL images show bilateral superior temporal gyri
Endovascular treatment and afterward
Immediate conventional catheter digital subtraction angiography was done and it showed severe vasospasm in the right MCA [
(a) Right ICA angiography showing spasm in the right MCA. (b) A microcatheter was advanced to the right M1 and papaverine was administered from there. (c) The right MCA spasm improved after the papaverine administration. (d) Conservative air conduction audiogram obtained at the onset of deafness, showing severe hearing loss bilaterally. After the endovascular treatment, her hearing ability became normal level bilaterally
Cortical deafness and auditory agnosia are usually related to each other and are frequently associated with aphasia.[
A number of cases of cortical deafness have been reported in the literature, with the most frequent causes being congenital and cerebral infarction or hemorrhage.[
Although both transluminal balloon angioplasty (TBA) and intraarterial vasodilator therapy (IAVT) can be effective in relieving proximal symptomatic PHCV, only IAVT is a viable treatment option for distal vasospasm. The main advantage of TBA is its long-lasting therapeutic effect and the very low rate of retreatment. However, its use has been associated with a significant risk of serious complications, particularly vessel rupture and reperfusion hemorrhage. Conversely, IAVT is generally considered an effective and low-risk procedure, despite the transient nature of its therapeutic effects.[
1. Godefroy O, Leys D, Furby A, De Reuck J, Daems C, Rondepierre P. Psychoacoustical deficits related to bilateral subcortical hemorrhages. A case with apperceptive auditory agnosia. Cortex. 1995. 31: 149-59
2. Graham J, Greenwood R, Lecky B. Cortical deafness: A case report and review of the literature. J Neurol Sci. 1980. 48: 35-49
3. Griffiths TD. Central auditory pathologies. Br Med Bull. 2002. 63: 107-20
4. Kato Y, Araki N, Matsuda H, Ito Y, Suzuki C. Arterial spin-labeled MRI study of migraine attacks treated with rizatriptan. J Headache Pain. 2010. 11: 255-8
5. Ogane K, Fujii Y, Hatanaka M. A case of subarachnoid hemorrhage complaining of deafness. No To Shinkei. 1998. 50: 443-6
6. Ponzetto E, Vinetti M, Grandin C, Duprez T, van Pesch V, Deggouj N. Partly reversible central auditory dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg. 2013. 119: 1125-8
7. Rahme R, Jimenez L, Pyne-Geithman GJ, Serrone J, Ringer AJ, Zuccarello M. Endovascular management of posthemorrhagic cerebral vasospasm: Indications, technical nuances, and results. Acta Neurochir Suppl. 2013. 115: 107-12
8. Senbokuya N, Kinouchi H, Kanemaru K, Ohashi Y, Fukamachi A, Yagi S. Effects of cilostazol on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: A multicenter prospective, randomized, open-label blinded end point trial. J Neurosurg. 2013. 118: 121-30
9. 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