BILATERAL TOTAL DEAFNESS DUE TO PONTINE HEMATOMA

A 64 year old woman with a predominantly midline pontine tegmental hae morrhage presented with bilateral total deafness. One week later reaso nable pure-tone thresholds appeared but she still had total bilateral loss of speech discrimination. At that rime contralateral acoustic ref lexes were bilaterally absent, whereas ipsilateral acoustic reflexes a nd waves IV and V of the brainstem auditory evoked potential were bila terally preserved. It is proposed that this patient's hearing deficit was due to inactivation of the ventral acoustic striae decussating in the trapezoid body, This case supports the contention that in humans t he ventral pontine acoustic decussation carries most of the neural sig nals required for hearing and perhaps all the neural signals required for speech perception.