Localization of Bilateral Auditory Hallucinations and Correlation to Imaging in Posterior Circulation Stroke

Auditory hallucination in basilar occlusion: I heard it was the basilar

Acute basilar artery occlusion is a neurological emergency. Unlike anterior circulation stroke presenting with hemiparesis, the symptoms of basilar artery occlusion are challenging to recognise in the emergency setting. Basilar artery occlusion can rarely lead to ischaemia of the auditory pathways, resulting in bizarre, positive auditory hallucinations. Here, we report two cases of basilar artery occlusion presenting with positive auditory phenomena; in both cases the auditory phenomenon resolved upon arterial recanalisation. We discuss the phenomenology of this unusual and distinctive neurological symptom. Acute auditory hallucinosis in the setting of sudden vomiting, dizziness, visual disturbance or other posterior circulation symptoms should prompt emergency imaging of the basilar artery, to avoid a potentially devastating posterior circulation stroke.

Hearing disorders in stroke

Stroke may affect all levels of the auditory pathway and lead to hearing reception and/or perception deficits. Sudden-onset hearing loss after stroke of the vertebrobasilar territory and/or low brainstem is one of the less frequent neurologic impairments, while cortical or central deafness is even rarer. However, studies of populations with stroke indicate that hearing loss is very common, while in the general population, a past history of stroke increases the likelihood of having hearing loss. Auditory-processing deficits after stroke are less well studied than hearing loss and possibly underdocumented. Auditory dysfunction may impact on patient communication and may even predict long-term patient outcome after stroke. Despite this, clinical guidelines for auditory assessments after stroke are rudimentary. This chapter reviews the available information of auditory function in patients with stroke. On the basis of the information available, it is suggested that screening the patient's hearing before the patient leaves the stroke ward with a short test and a minimum set of hearing-related questions and subsequently screening the patient's hearing needs with targeted questions at the chronic stage of stroke may be a cost-effective bare-minimum assessment approach to addressing the hearing needs of this complex population.