Case report: Near-complete cortical hearing loss caused by sequential development of bilateral putaminal hemorrhage

Abstract

Intracerebral hemorrhage with sudden hearing loss as the initial symptom is rare. A right-handed man with a history of right putaminal hemorrhage developed near-complete hearing loss and right hemiplegia and was taken to our hospital by ambulance. Non-contrast computed tomography demonstrated acute intracerebral hemorrhage in the left putamen. A region of old right putaminal hemorrhage involving the right temporal stem was also shown on fluid-attenuated inversion recovery. Standard pure-tone audiometry showed right-dominant bilateral sensorineural hearing loss. More than 2 months after onset, the bilateral sensorineural hearing loss gradually improved without interfering with daily life. Detailed history-taking indicated that the old hemorrhage in the right putamen 12 years previously had caused sudden left-dominant bilateral hearing impairment due to asymmetric but bilateral innervation from the auditory nerve. The bilateral damage to the temporal stem involving acoustic radiation resulted in temporary near-complete hearing loss after the recurrence, but the amelioration of edema in the left temporal stem may have resulted in partial recovery of the hearing loss. This patient's clinical progression suggests that the auditory tract ascends mainly on the side opposite the ear and may explain the left dominance in the level of acoustic radiation.

Keywords

• Sudden bilateral hearing loss
• Intracerebral hemorrhage
• Putaminal hemorrhage
• Recovery of cortical hearing loss