以突聋为首发症状的脑梗死患者临床特点

Clinical characteristics of cerebral infarction with a prodromal symptom of sudden sensorineural hearing loss

摘要:

目的 探讨以突聋为首发症状的脑梗死患者的临床特点，提高对该类情况的认识，尽早做出正确诊断。方法 报道我院2014年收治的2例以突聋为首发症状的脑梗死病例，均完善头颅MRI、HR-MRI、DSA、颈动脉超声、TCD检查，结合文献复习，总结临床特点。结果 该2例患者首发症状表现为突聋合并头晕，DSA均发现基底动脉近段狭窄。病例1头颅MRI示双侧桥脑及左侧小脑新发梗死灶，予急诊动脉溶栓治疗，后续双联抗血小板聚集及他汀治疗，听力好转。病例2头颅MRI示右侧桥脑新发梗死灶，予双联抗血小板聚集及他汀治疗，遗留听力下降。结论 以突聋为首发症状的脑梗死并不罕见，突聋患者应尽快完善脑血管检查，突聋患者具有以下临床特点时需要高度警惕脑梗死：伴随头晕症状、合并多种动脉粥样硬化危险因素、基底动脉狭窄。

Abstract:

Objective To investigate the clinical characteristics of cerebral infarction with a prodromal symptom of sudden sensorineural hearing loss, and to deepen understanding of the disease and reduce misdiagnosis.Methods Two cerebral infarction patients with a prodromal symptom of sudden sensorineural hearing loss who were admitted to our hospital in 2014 were enrolled as subjects. The two patients underwent magnetic resonance imaging (MRI), high-resolution MRI, digital subtraction angiography (DSA), carotid ultrasound, and transcranial Doppler examination. The clinical characteristics were summarized based on the clinical data and literature review.Results The prodromal symptoms of the two patients were sudden sensorineural hearing loss and dizziness. DSA showed stenosis in the proximal basilar artery. Brain MRI revealed new-onset infarction in bilateral pontine and left cerebellum of one patient. Emergent arterial thrombolytic therapy and subsequent dual antiplatelet and statin therapy achieved hearing recovery. Brain MRI revealed new-onset infarction in the right pontine of the other patient. Hearing was partially recovered after dual antiplatelet and statin therapy.Conclusions Cerebral infarction with a prodromal symptom of sudden sensorineural hearing loss is not rare. Patients with sudden sensorineural hearing loss should undergo cerebrovascular examinations as soon as possible. Clinical characteristics including dizziness, multiple risk factors for atherosclerosis, and basilar artery stenosis indicate a high risk of cerebral infarction.