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(Stroke. 2003;34:837.)
© 2003 American Heart Association, Inc.

Letters to the Editor

AICA Infarction and Hearing Loss: Is it Peripheral or Central?

Service de Neurologie, Centre Hospitalier de Luxembourg, Luxembourg

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

I very much appreciated the article by Lee et al¹ on the important hearing loss in anterior inferior cerebellar artery (AICA) stroke as they address the neglected issue of hearing loss in neurologic disease. They confirm the notion that peripheral and central disorders of the VIIIth nerve are likely to be confounded.² Despite the unusual work-up, there are several pitfalls in the terminology, and pathophysiology to be addressed.

The term auditory brain stem response (ABR) is strongly misleading and I advocate the use of auditory evoked potential (AEP). The former would imply a generation of the entire response in the brain stem. The latter describes the modality and the evoked response type. It has become increasingly clear that the wave I of the AEP is generated outside the brain stem, and probably represents the change of conductivity when the VIIIth nerve leaves the temporal bone. The same might apply to wave II, where the nerve enters the brain stem.³ So the interpeak latencies might reflect different pathophysiologies. The I-III interval may thus reflect a sensorineural lesion (delayed or abolished wave I/II) as well as a central lesion (wave III, probably generated at the level of the superior olivary complex.^4,5 Interestingly, the AEP shown for the central-type shows complete loss of all waves, following standard criteria suggestive of peripheral loss.⁶ The lesions shown for the two cases do not differ significantly in my opinion, but demonstrate as well a spotty lesion pattern in the lateral pons as well . . . [Full Text of this Article]

Hyung Lee, MD, PhD

Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea

Robert W. Baloh, MD

Department of Neurology, UCLA School of Medicine, Los Angeles, California

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