Short communicationBilateral deafness as a prodromal symptom of basilar artery occlusion
Introduction
Basilar artery occlusion often ends in death or major disability, including tetraplegia and coma [1], [2], [3], although a very recent review stresses low possibility of such miserable outcomes (7.7%) [4]. Patients with basilar artery occlusion often have minor stroke or transient ischemic attacks preceding fatal stroke [2], [5], [6]. The most common prodromal symptoms are motor and oculomotor deficits, with vertigo, nausea and headache occurring less frequently [2], [5], [6]. Hearing loss or tinnitus is not a major prodromal symptom (6% or less), and usually appears to develop with other symptoms [2], [5], [6]. Thus, it may be difficult to consider sudden deafness alone as a prodromal symptom of basilar artery occlusion.
Because basilar artery occlusion is potentially treatable, for example by thrombolysis [7], it is essential not to overlook any prodromal symptoms of this disease. Bilateral deafness seems to be a rare but one of possible prodromal symptoms. Here, we describe two patients with basilar artery occlusion who developed sudden bilateral deafness, soon followed by coma.
Section snippets
Case report
Patient 1: A 51-year-old barber had histories of hypertension, diabetes, and hypercholesterolemia, and a family history of ischemic stroke that his father and brother developed at the age of 42. He did not notice the alarm clock one morning. Right after being woken up by his wife, he barely heard her speaking, and soon afterward, he could not hear at all. He felt dizziness while walking.
On arrival at our hospital an hour after waking up, his blood pressure was 145/80 mm Hg, his pulse rate was
Discussion
An important point of this report is that sudden bilateral deafness can precede fatal neurological deficits by basilar artery occlusion. Occlusion of the basilar arterial origin suggests that thrombosis, but not embolism, is the primary mechanism of the stroke [4], [6]. In addition, Patient 1 had risk factors for atherosclerosis and a family history of young-onset stroke. Dissection is another possible mechanism for occlusion of the basilar origin, although much rarer compared to thrombosis [8]
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