Pneumococcal meningitis with accompanying severe hearing loss: 3D-FLAIR imaging of the inner ear and treatment

  • Hara Naoyuki
    Department of Neurology, Brain Attack Center Ota Memorial Hospital Present Address: Department of Neurology, Hiroshima City Hospital
  • Yunoki Taijun
    Department of Neurology, Brain Attack Center Ota Memorial Hospital Present Address: Department of Neurology and Neuroscience, Okayama University School of Medicine
  • Kubo Satoshi
    Department of Neurology, Brain Attack Center Ota Memorial Hospital Present Address: Department of Clinical Neuroscience and Therapeutics, Hiroshima University
  • Fujii Hiroki
    Department of Neurology, Brain Attack Center Ota Memorial Hospital Present Address: Department of Clinical Neuroscience and Therapeutics, Hiroshima University
  • Takamatu Kazuhiro
    Department of Neurology, Brain Attack Center Ota Memorial Hospital
  • Tanaka Akio
    Department of Radiology, Brain Attack Center Ota Memorial Hospital
  • Kuriyama Masaru
    Department of Neurology, Brain Attack Center Ota Memorial Hospital

Bibliographic Information

Other Title
  • 高度難聴を合併した肺炎球菌性髄膜炎―内耳MRI画像所見と治療の試み―

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Description

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.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 55 (2), 119-122, 2015

    Societas Neurologica Japonica

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