A stroke of silence: tinnitus suppression following placement of a deep brain stimulation electrode with infarction in area LC

Case report

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The authors report on a case of tinnitus suppression following deep brain stimulation (DBS) for Parkinson disease. A perioperative focal vascular injury to area LC, a locus of the caudate at the junction of the head and body of the caudate nucleus, is believed to be the neuroanatomical correlate.

A 56-year-old woman underwent surgery for implantation of a DBS lead in the subthalamic nucleus to treat medically refractory motor symptoms. She had comorbid tinnitus localized to both ears. The lead trajectory was adjacent to area LC. Shortly after surgery, she reported tinnitus suppression in both ears. Postoperative MRI showed focal hyperintensity of area LC on T2-weighted images. At 18 months, tinnitus localized to the ipsilateral ear remained completely silenced, and tinnitus localized to the contralateral ear was substantially suppressed due to left area LC injury.

To the authors' knowledge, this is the first report of a discrete injury to area LC that resulted in bilateral tinnitus suppression. Clinicians treating patients with DBS may wish to include auditory phantom assessment as part of the neurological evaluation.

Abbreviations used in this paper:DBS = deep brain stimulation; LC = locus of caudate; PD = Parkinson disease.

Article Information

Address correspondence to: Paul S. Larson, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, California 94143-0112. email: larsonp@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online October 19, 2012; DOI: 10.3171/2012.9.JNS12594.

© AANS, except where prohibited by US copyright law.

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    A: Early postoperative MR image showing the DBS lead position (arrow) lateral to the caudate nucleus and focal T2 signal hyperintensity involving the anterior body of the caudate. B: Graph showing tinnitus perception changes in the right and left ears. C: Postoperative audiogram documenting symmetric mild high-frequency sensorineural hearing loss, without asymmetry of hearing thresholds.

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