title: Fluctuating hearing loss, episodic headache, and stroke with platelet hyperaggregability: coexistence of auditory neuropathy and cochlear hearing loss.
abstract: We encountered a 10-year-old girl with fluctuating sensorineural hearing loss, episodic headache, and white matter stroke. Strenuous exercise, febrile illness, and general anesthesia all temporarily worsened hearing. Audiologic findings were asymmetric: left-sided retrocochlear dysfunction consistent with auditory neuropathy contrasted with cochlear hearing loss in the right ear. Platelets obtained during a headache-free period showed excessive responsiveness to collagen in vitro, while episodic elevations of thromboxane B(2) and thrombin-antithrombin III complex were noted in blood sampled during headache. Treatment of hyperaggregability of platelets with aspirin and antioxidant vitamins relieved headache, while adenosine triphosphate administration improved hearing thresholds. In this patient, hearing impairment and white matter strokes appeared to respectively related to impaired blood flow to the cochlea and white matter caused by platelet dysfunction triggered by physiologic stresses.
authors.affiliation: Department of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. nobutoki1206@ninus.ocn.ne.jp
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Nobutoki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sasaki
authors.forename: Michio
authors.initials: M
authors.lastname: Fukumizu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Hanaoka
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugai
authors.forename: Yuki
authors.initials: Y
authors.lastname: Anzai
authors.forename: Makiko
authors.initials: M
authors.lastname: Kaga
mesh_terms: D000255:Adenosine Triphosphate / Q000627:therapeutic use; D000990:Antithrombin III / Q000378:metabolism; D001299:Audiometry / Q000379:methods; D001792:Blood Platelets / Q000378:metabolism; D002648:Child; D003094:Collagen / Q000378:metabolism; D016057:Evoked Potentials, Auditory, Brain Stem / Q000187:drug effects / Q000502:physiology; D005260:Female; D007839:Functional Laterality; D006261:Headache / Q000097:blood* / Q000150:complications / Q000473:pathology; D006319:Hearing Loss, Sensorineural / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010447:Peptide Hydrolases / Q000378:metabolism; D010974:Platelet Aggregation / Q000502:physiology*; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000473:pathology; D013929:Thromboxane B2 / Q000378:metabolism
chemical_list: C046193:antithrombin III-protease complex; D013929:Thromboxane B2; D000255:Adenosine Triphosphate; D000990:Antithrombin III; D003094:Collagen; D010447:Peptide Hydrolases