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Between 1986 and 1992,we encountered seven patients(four,men,three women; median age,61 years;range,46-71 years)who had sudden bilateral hearing impairment among 503 patients with vertebrobasilar occlusive disease.The main initial neurologica;symptoms were a sudden bilateral hearing impairment,tinnitus,and vertigo.Acute labyrinthitis or Meniere's disease was the inital diagnosis until subsequent brain stem or cerebellar signs appeared.Brain stem auditory evoked potentials were abnormal bilaterally in six patients but had unilateral attenuation of the IV-V complex in the remaining one patient.Computed tomographic scans in all six patients showed multiple hypodense lesions in the brain stem and cerebellum. Cerebral angiography showed complete occlusion on both vertebral arteries in one patient,occlusions on the left with small caliber on the right in another,and severe stenosis on both sides in a third.There was no opacification of the internal auditory arteries in these three patients. The remaining patient had arteriosclerotic changes with faint opacification of the bilateral internal auditory arteries.Five patients had a poor prognosis,with locked-in state in four and severe truncal ataxia in one.We conclude that sudden bilateral hearing impairment in vertebrobasilar occlusive disease is more common than previously recognized and that it may indicate a grave prognosis. |
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auditory evoked brainstem potentials
brainstem,infarction of
CAT scan
CAT scan,abnormal
cerebrovascular accident
hearing loss
hearing loss,sudden,bilateral
internal auditory artery
internal auditory artery,occlusion
locked-in syndrome
tinnitus
vertebral artery occlusion
vertebral artery occlusion,bilateral
vertebral artery stenosis
vertebral artery stenosis,bilateral
vertigo
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