Bilateral sudden deafness as the main symptom in cerebral hemorrhage

Introduction Bilateral sudden central deafness as the initial manifestation of supratentorial intracerebral hemorrhage is rare. Reporting such cases may improve understanding of the clinical presentation and potential mechanisms of injury involving the central auditory pathway. Case presentation We report a 60-year-old man who presented with acute bilateral hearing loss and numbness of the right extremity. He had a history of hypertension and had experienced a right putaminal hemorrhage 3 years earlier, at which time no auditory symptoms were noted. On the current admission, non-contrast head CT demonstrated an acute hemorrhage in the left putamen and a slit-like lesion in the right putamen consistent with remote hemorrhagic residue. Pure tone audiometry confirmed bilateral sensorineural hearing loss. After systematic treatment and rehabilitation, the patient's hearing improved markedly within 2 months and no longer significantly affected daily life. Conclusion This case suggests that when unilateral intracerebral hemorrhage presents with bilateral sudden central deafness, clinicians should carefully evaluate for possible pre-existing lesions in the contralateral auditory pathway. Based on this case and the relevant literature, we tentatively propose preliminary anatomical and clinical classification frameworks for this rare condition. These frameworks are hypothesis-generating and require further validation.