A Case of Auditory Neuropathy Caused by Pontine Hemorrhage in an Adult
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A pontine hemorrhage can evoke several neurological symptoms because the pons containsvarious nuclei and nerve fibers. Hearing loss can develop as a result of a pontine hemorrhagebecause there is an auditory conduction pathway in the cochlear nucleus of thepons. However, very few cases of hearing loss caused by pontine lesions have been reported,and there have been no reports of auditory neuropathy that developed following a pontinehemorrhage. Recently we had a patient who experienced a nontraumatic pontine hemorrhagewho was diagnosed with auditory neuropathy. The 34-year-old male patient wasadmitted to the emergency department with sudden alteration of mental status. His braincomputed tomographic imaging revealed a hemorrhage in the central pons. He complainedof hearing difficulties after his mental status recovered through conservative treatment, but apure-tone audiogram showed very mild hearing loss in both ears. Further hearing tests usingotoacoustic emissions, which showed normal responses, and auditory brainstem responses,which showed no waveforms at maximum stimulus intensity, revealed that his hearing difficultieswere caused by auditory neuropathy. This case implies that the threshold of sound detectioncan be preserved in patients with pontine hemorrhage who complain of hearing difficulties. Auditory neuropathy should be considered as a possible cause of hearing difficultiesin these patients and appropriate hearing tests should be performed.
Abstract
A pontine hemorrhage can evoke several neurological symptoms because the pons containsvarious nuclei and nerve fibers. Hearing loss can develop as a result of a pontine hemorrhagebecause there is an auditory conduction pathway in the cochlear nucleus of thepons. However, very few cases of hearing loss caused by pontine lesions have been reported,and there have been no reports of auditory neuropathy that developed following a pontinehemorrhage. Recently we had a patient who experienced a nontraumatic pontine hemorrhagewho was diagnosed with auditory neuropathy. The 34-year-old male patient wasadmitted to the emergency department with sudden alteration of mental status. His braincomputed tomographic imaging revealed a hemorrhage in the central pons. He complainedof hearing difficulties after his mental status recovered through conservative treatment, but apure-tone audiogram showed very mild hearing loss in both ears. Further hearing tests usingotoacoustic emissions, which showed normal responses, and auditory brainstem responses,which showed no waveforms at maximum stimulus intensity, revealed that his hearing difficultieswere caused by auditory neuropathy. This case implies that the threshold of sound detectioncan be preserved in patients with pontine hemorrhage who complain of hearing difficulties. Auditory neuropathy should be considered as a possible cause of hearing difficultiesin these patients and appropriate hearing tests should be performed.
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