突発性難聴の治療経過中に小脳梗塞が判明した症例

A case of sudden deafness coinciding with cerebellar infarction

I．はじめに

　難聴，耳鳴，耳閉感などの聴覚症状は，内耳性疾患が予測されるが，しばしば脳血管障害などの中枢性疾患の初発症状であることがある。特に，小脳梗塞は初診時に第Ⅷ脳神経以外には神経症候が乏しい場合があり鑑別に注意を要する^1～3）。

　われわれは聴覚症状が主訴で突発性難聴と診断し，その治療経過中に小脳梗塞が判明した症例を経験した。本稿では症例を呈示し，その難聴と小脳梗塞との関連，難聴の治療前の中枢性疾患の除外診断の重要性を検討する。

　A 75-year-old man complained of right acute hearing loss,tinnitus,and aural fullness. Right-sided sudden deafness with the hearing level of 50dB was diagnosed. Steroid,vitamin B₁₂ and ATP were administered in hospital. During the treatment,symptoms of disorientation,nausea,and dizziness were observed. Emergent CT and MRI confirmed a cerebellar infarction in the PICA territory. Therefore,we changed the therapy for infarction. Consequently,right-sided hearing loss remained the same. The patient has been followed-up by a physician. This case reminded us not to overlook the cerebrovascular disorder,even if the elderly patients with many complications presented with only aural symptoms.