Intraarterial vasodilator therapy immediately rescued pure cortical deafness due to bilateral cerebral vasospasm

Abstract

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.

Endovascular combined and multistep surgical treatment of complicated intracranial aneurysmal hemorrhage

“…Неможливість санації базальних цистерн при ендоваскулярній оклюзії аневризм змушує шукати нові способи санації ліквору, такі як «ITSUKI therapy», раннє зовнішне люмбальне дренування, «масивна заміна цереброспінальної рідини» [9][10][11]. Ендоваскулярний метод активно застосовують у лікуванні вазоспазму з використанням фармакологічних препаратів (папаверин, німодипін), які вводять внутрішньоартеріально, або балонної ангіопластики [12][13][14]. Дискутабельним є питання, який інтракра-ніальний крововилив унаслідок розриву церебральної аневризми вважати ускладненим.…”

Role of Microvascular Disruption in Brain Damage from Traumatic Brain Injury

“…CT angiography is the diagnostic gold standard for vasospasm (156). Endovascular treatment and vasodilator therapy have both proven to be successful treatment approaches (11, 81). …”