Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

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

Naoyuki Hara, M.D.1)3), Taijun Yunoki, M.D.1)4), Satoshi Kubo, M.D.1)5), Hiroki Fujii, M.D.1)5), Kazuhiro Takamatu, M.D.1), Akio Tanaka, M.D.2) and Masaru Kuriyama, M.D., Ph.D.1)

1)Department of Neurology, Brain Attack Center Ota Memorial Hospital
2)Department of Radiology, Brain Attack Center Ota Memorial Hospital
3)Present Address: Department of Neurology, Hiroshima City Hospital
4)Present Address: Department of Neurology and Neuroscience, Okayama University School of Medicine
5)Present Address: Department of Clinical Neuroscience and Therapeutics, Hiroshima University

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.
Full Text of this Article in Japanese PDF (447K)

(CLINICA NEUROL, 55: 119|122, 2015)
key words: pneumococcal meningitis, hearing loss, 3D-FLAIR, immune response, steroid pulse therapy

(Received: 9-Apr-14)