[A case of postinfectious polyradiculoneuropathy initially manifested as sudden and severe bilateral hearing loss]

Abstract

A 48-year-old man noted epi-gastralgia, right back pain and lumbago. One week later he developed sudden and severe bilateral hearing loss and progressive difficulty in walking due to generalized muscle weakness of the four extremities. In AIDP, involvement of the 8th cranial nerve is very rare. At the initial stage of the illness ABR disclosed prolonged latency of wave V, and other waves were not detected at all. Thereafter the ABR findings improved gradually with concomitant improvement of the clinical signs and symptoms, and waves I and III became identifiable together with a shortening of the latency of wave I. These ABR findings suggest that the main lesion in this patient involves the peripheral part of the cochlear nerve. Antibody titers for HSV-I were high in CSF and serum at the initial stage, and decreased gradually in parallel with the improvement of the neurological signs and symptoms. Seven cases of AIDP or Guillain-Barré syndrome with impairment of the 8th cranial nerve have been reported in the literature. Nevertheless, the present case is of interest because of the severity of the hearing impairment and also because this is the first case for which the time courses of ABR findings and HSV-I antibody titers are available.