Brainstem auditory evoked potentials (BAEPs), pathology of wave IV

In a group of 134 consecutive patients with brainstem symptomatology wave IV was bilaterally absent in 69%. Bilateral absence of this wave can be considered as a normal state. Only absence of wave IV on one side with its presence on the other side was appraised as pathologic. Asymmetries of the latency and amplitude could not be taken into consideration because of the lack of normative data for this wave. Computer tomography showed in our pathologic cases lesions in the pons, oblongata and cerebellum. The clinical semiology was extensive and multiform pointing in 84% to a pontine origin, in 16% to a lesion of the midbrain or oblongata. A possible lesion of the pons was in accordance with its functional anatomy as well as with the supposed origin of wave IV (superior olivar complex, lateral lemniscal nucleus). In 62% of cases the pathology of wave IV was present without impairment of auditory functions. The pathology of wave IV was considered as little sensitive and little specific.