Partly reversible central auditory dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage

J Neurosurg. 2013 Nov;119(5):1125-8. doi: 10.3171/2013.7.JNS13674. Epub 2013 Aug 23.

Abstract

The authors describe a rare case of central auditory dysfunction induced by cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). A 55-year-old woman who was admitted after aneurysmal SAH developed cerebral vasospasm on Day 3 affecting mainly the right middle cerebral artery (MCA) and partly the left MCA. The vasospasm became refractory to conventional therapy and was ultimately improved by intraarterial infusion of nimodipine in the right MCA and angioplasty. Severe auditory dysfunction was apparent from Day 10 as the patient was not reactive to speech or environmental sounds. Brain MRI on Day 17 demonstrated infarcted areas mainly in the right hippocampus, medial occipital lobe, and thalamus. The patient underwent further examination using audiometry, speech testing, auditory evoked potentials, functional MRI, and cerebral PET. The initial diagnosis was extended nonverbal agnosia and total pure word deafness. The central auditory dysfunction improved over 6 months, with persisting hyperacusis, tinnitus, and amusia. Central auditory dysfunction is a rare complication after SAH. While cortical deafness may be associated with bilateral lesions of the temporal cortex, partly reversible central auditory dysfunction was observed in this patient after prominently unilateral right temporal lesions. The role of the interthalamic connections can be discussed, as well as the possibility that a less severe vasospasm on the left MCA could have transiently impaired the left thalamocortical auditory pathways.

Publication types

  • Case Reports

MeSH terms

  • Angioplasty / methods
  • Auditory Diseases, Central / diagnosis*
  • Auditory Diseases, Central / etiology
  • Auditory Diseases, Central / therapy
  • Female
  • Humans
  • Middle Aged
  • Middle Cerebral Artery / drug effects
  • Middle Cerebral Artery / pathology*
  • Nimodipine / administration & dosage
  • Nimodipine / pharmacology
  • Subarachnoid Hemorrhage / complications
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage
  • Vasodilator Agents / pharmacology
  • Vasospasm, Intracranial / complications*
  • Vasospasm, Intracranial / etiology
  • Vasospasm, Intracranial / therapy

Substances

  • Vasodilator Agents
  • Nimodipine