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A Case of Hearing Loss after Bilateral Putaminal Hemorrhage: A Diffusion-tensor Imaging Study.

Background
Magnetic resonance diffusion-tensor imaging (DTI) is a tool for the assessment of neural fiber integrity. We applied DTI in a patient with hearing loss that developed after bilateral putaminal hemorrhage.


Case
A 59-year-old woman was referred to our outpatient clinic for sequelae diagnosis. Six years earlier, she had suffered a left putaminal hemorrhage, but almost fully recovered. Four years later, she suffered a right putaminal hemorrhage, resulting in severe left hemiparesis and hearing loss. After receiving conservative acute care treatment, she was transferred to a long-term rehabilitation facility and returned home 7 months later, when her Functional Independence Measure score was 103 points. Although the patient could not respond to auditory stimuli, her writing and reading abilities were intact. Auditory examinations indicated that the brainstem response was normal, but pure tone audiometry was at the low end of the scale (105 dB). We examined the patient's brain using DTI, and the lesions were assessed in reference to the standard brain map transformed into her individual brain space. Fractional anisotropy and color brain maps indicated that the lesions were located within bilateral acoustic radiations. In addition, we applied fiber tracking analysis in which voxels of the medial geniculate bodies in the standard brain map were transformed into the patient's individual brain space and then taken as seeds for the fiber tracking. The resulting image showed bilateral disruption of acoustic radiation fibers.


Conclusion
By applying DTI, we identified the neuroanatomical pathology of hearing loss that developed after bilateral putaminal hemorrhage.