中樞神經血管變異與耳鳴間可能的關係－病例報告

The Possible Relationship between Central Nervous Vascular Anomalies and Tinnitus-Case Report

10.30145/STJHMNJ.201006.0005

陳建志(Jiann-Jy Chen)；劉智仰(Chih-Yang Liu)；孫盛義(Sheng-Yih Sun)；陳登郎(Dem-Lion Chen)

耳鳴 ； 後顱窩循環 ； 威利氏環 ； 前下小腦動脈 ； tinnitus ； posterior circulation ； circle of Willis ； anterior inferior cerebellar artery

若瑟醫護雜誌

4卷1期（2010 / 06 / 01）

51 - 57

繁體中文

耳鳴大多原因不明，可能涉及內耳耳蝸、耳蝸後聽神經、聽覺神經路徑或聽覺中樞皮質。一59歲男性，因左側耳鳴40多年及右側耳鳴1年求診於本院，純音聽力檢查顯示左耳感音性聽障較右耳嚴重，兩耳均有4,000 Hz處凹陷，血中膽固醇值及三酸甘油酯值偏高。頸部血管超音波顯示兩側頸總動脈有輕度的動脈硬化，左側椎動脈之血管阻力較右側為高。血管磁振造影呈現後方威利氏環不完整、後顱窩循環分支變異與左側顱內椎動脈向左偏倚成角。不僅僅是使用抗焦慮劑，在給予腦循環促進劑及降血脂劑1個月後，雖然左側耳鳴持續，右側耳鳴已經完全消失，血中膽固醇及三酸甘油酯值也已下降。耳鳴與聽障的致病機轉可能與中樞神經的血管變異有關，特別是在動脈硬化與高血脂症的情況下，如此，治療應設法先降低血管阻力與降低血脂值。本個案深具教育意義，特提出報告。

Most tinnitus is of unknown etiology, and may be from inner-ear cochlea, retro-cochlear auditory nerve, auditory pathway, or auditory cortex. A 59-year-old male presented with left tinnitus for over 40 years and right tinnitus for over a year. Pure tone audiometry showed his left ear had a severer sensori-neural hearing impairment than right; besides, both ears had dips in 4,000 Hz. Blood examination reported hyper-cholesterolemia and hyper-triglyceridemia. Neck duplex ultrasonography reported mild atherosclerosis of bilateral common carotid arteries, and increased vascular resistance of left vertebral artery. Magnetic resonance angiography revealed defects of posterior circle of Willis, deficient branches of posterior circulation, and a left deviated angulation of left intracranial vertebral artery. In addition to anti-anxiety, a brain circulatory promoter and an anti-lipid were given. After a month, right tinnitus subsided though left tinnitus persisted; besides, the blood cholesterol and triglyceride decreased. In conclusion, tinnitus and hearing impairment might be related with central nervous vascular variants, especially complicated with atherosclerosis and hyperlipidemia; thus, to reduce the vascular resistance and blood lipid is recommended. We hereby reported this case for education.