TY - JOUR
T1 - Pneumococcal meningitis with accompanying severe hearing loss
T2 - 3D-FLAIR imaging of the inner ear and treatment
AU - Hara, Naoyuki
AU - Yunoki, Taijun
AU - Kubo, Satoshi
AU - Fujii, Hiroki
AU - Takamatu, Kazuhiro
AU - Tanaka, Akio
AU - Kuriyama, Masaru
PY - 2015
Y1 - 2015
N2 - A 66-year-old man was admitted to our hospital because of unconsciousness. He was diagnosed with pneumococcal meningitis and treated with a combination of antibiotics (meropenem hydrate), dexamethasone, and intravenous immunoglobulin. Although he gradually regained consciousness, he started showing signs of hearing disturbance. Measurement of auditory brainstem response revealed severe sensorineural hearing loss. The patient then underwent three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging, which revealed increased signals in the cochlea and the vestibuum, and their enhancement after gadolinium administration. This enhancement was still observed on images of the inner ear acquired on the 52nd hospital day. These findings suggested that the change of content in the lymph and the damage to the blood-labyrinth barrier was caused and aggravated by an immune response. Recent studies have shown that an MyD88-dependent immune response contributes to hearing loss in an experimental mouse model of pneumococcal meningitis. The patient was administered steroid pulse and hyperbaric oxygen therapies for improving the hearing deficit, but these therapies were discontinued because of the aggravation of hepatitis B and diabetes mellitus, which he had developed previously.
AB - A 66-year-old man was admitted to our hospital because of unconsciousness. He was diagnosed with pneumococcal meningitis and treated with a combination of antibiotics (meropenem hydrate), dexamethasone, and intravenous immunoglobulin. Although he gradually regained consciousness, he started showing signs of hearing disturbance. Measurement of auditory brainstem response revealed severe sensorineural hearing loss. The patient then underwent three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging, which revealed increased signals in the cochlea and the vestibuum, and their enhancement after gadolinium administration. This enhancement was still observed on images of the inner ear acquired on the 52nd hospital day. These findings suggested that the change of content in the lymph and the damage to the blood-labyrinth barrier was caused and aggravated by an immune response. Recent studies have shown that an MyD88-dependent immune response contributes to hearing loss in an experimental mouse model of pneumococcal meningitis. The patient was administered steroid pulse and hyperbaric oxygen therapies for improving the hearing deficit, but these therapies were discontinued because of the aggravation of hepatitis B and diabetes mellitus, which he had developed previously.
KW - 3D-FLAIR
KW - Hearing loss
KW - Immune response
KW - Pneumococcal meningitis
KW - Steroid pulse therapy
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U2 - 10.5692/clinicalneurol.55.119
DO - 10.5692/clinicalneurol.55.119
M3 - Article
C2 - 25746077
AN - SCOPUS:84923248933
SN - 0009-918X
VL - 55
SP - 119
EP - 122
JO - Clinical Neurology
JF - Clinical Neurology
IS - 2
ER -
