Sudden Bilateral Hearing Loss Is a Neurovascular Emergency

Sudden bilateral hearing loss is not commonly encountered by neurologists. Many first-line providers commonly label hearing loss as peripheral in origin, leading to misdiagnosis and delayed treatment. A 49-year-old female presented with sudden bilateral hearing loss and headache. Neurologic examination revealed mild right-sided weakness, sensory loss, and ataxia. CT scan of the brain revealed left mid-dorsal pontine intraparenchymal hemorrhage. Further testing with MRI brain and brainstem auditory evoked potentials (BAEPs) confirmed a central etiology of hearing loss. Prompt diagnosis and treatment resulted in complete resolution of hearing loss and only mild, nondisabling sensorimotor deficits at 3-month clinic follow-up. This case emphasizes the importance of treating sudden-onset bilateral hearing loss as a neurologic emergency until proven otherwise. We discuss the etiologies of sudden-onset sensorineural hearing loss and carefully localize the lesion to the brainstem in this rare presentation of a pontine syndrome. We highlight common principles of BAEP testing and expected findings in patients with stroke and demyelinating lesions.