This 55-year-old female was admitted to our hospital with SAH caused by a ruptured left internal carotid artery (ICA) paraclinoid
aneurysm. Computed tomography (CT) scans showed diffuse thick SAH with no other lesions such as an old
infarction or
hemorrhage. Emergent
stent-assisted coil embolization was performed successfully and subsequent cisternal irrigation with
urokinase almost completely washed out the thick SAH. During follow-up, she was alert and without any neurological deficits, however, she developed acute
bilateral deafness on day 7 even though she had no history of
hearing impairment. Because of the
deafness, verbal communication was difficult. She became almost completely unable to hear and communication was confined to writing. Immediate diffusion-weighted (DW) image showed high intensities in bilateral superior temporal gyri due to severe vasospasm of bilateral middle cerebral arteries (MCAs). Immediate angiography showed severe vasospasm especially right MCA. A microcatheter was advanced to the right M1 and
papaverine was administered. Soon after that, her
hearing impairment dramatically improved. Our simple audiometry showed a hearing threshold average for both 1000 and 4000 Hz at 25 dB in both ears. She was discharged without any deficits in 2 weeks.
CONCLUSIONS: To our knowledge, this is the first reported case of pure
cortical deafness due to bilateral vasospasm, which was immediately resolved by intraarterial administration of
papaverine.