[A case of cortical deafness with bilateral putaminal hemorrhage]

A 56 years old right-handed female, a housewife, had suffered from right putaminal hemorrhage which had been treated surgically in July, 1985. Since it was difficult to approach the trans-sylvian fissure, evacuation of the hematoma was performed transcortically through the superior temporal gyrus. She was neurologically free and lived normally until she suddenly became completely deaf in April, 1991. On admission, she was alert, well oriented and spontaneously stated that she was deaf. She showed no response to verbal commands or loud noises but followed complex written commands. No other neurological deficit was observed. In addition to an irregular low-density area in the right temporal lobe, CT scan revealed a left putaminal hemorrhage. Audiological testing disclosed pure tone thresholds to be below 90db on both sides. Auditory brain stem response (ABR) showed waves I to VI in normal latency ranges, but wave VII was not observed. She was treated conservatively. Although her hearing loss had been gradually improving for 1 month, she suffered from word deafness, an inability to comprehend speech, for the following 2 months. Clinical features, CT findings as well as results of ABR suggest that hearing loss observed in this case, cortical deafness, was presumably due to bilateral damage of acoustic radiation of the temporal lobe. It was also suggested that, although she was asymptomatic, cortical and subcortical damage to the right temporal lobe following evacuation of the putaminal hematoma may have been extensive. During surgical procedures for evacuation of the putaminal hematoma, it has to be always kept in mind not to damage the auditory cortex and its radiations.