脳脊髄液減少症が原因と考えられた急性感音難聴症例

Hearing impairment due to cerebrospinal fluid hypovolemia: a case report

はじめに

　脳脊髄液減少症は脳脊髄腔から脳脊髄液が持続的ないし断続的に漏出することによって脳脊髄液が減少し，頭痛，頸部痛，めまい，耳鳴りなどさまざまな症状を呈する疾患で，急性難聴，また変動する難聴をきたすことのある疾患の1つとして，突発性難聴，低音障害型感音難聴などとの鑑別において重要である。

　今回，われわれは，谷型の右急性感音難聴を呈し，脳脊髄液減少症の診断で硬膜外自己血液注入療法（ブラッドパッチ）が有効であった症例を経験したので報告する。

　Cerebrospinal hypovolemia is a syndrome resulting from cerebrospinal fluid leak. An orthostatic headache typically worsens on sitting up. It is also associated with ear-related symptoms, such as hearing disturbances, tinnitus, and vertigo. We report the case of a 50-year-old woman who had sustained a whiplash injury one year prior to presenting with acute sensorineural hearing loss of dip type. Magnetic resonance imaging revealed bilateral subdural hematoma and enlargement of the pituitary gland. Computed tomography myelography revealed cerebrospinal fluid leak at the upper thoracic level. Placement of an epidural blood patch alleviated the orthostatic headache and hearing loss. A repeat audiometry 7 days after the epidural blood patch showed complete recovery.