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.