Hypogeusia and hearing loss in a patient with an inferior collicular infarction

Various vascular syndromes have been described in patients with midbrain infarction.1,2 The clinical picture is dominated by third-nerve palsy, conjugate or disconjugate gaze impairment, contralateral motor and sensory deficit and homolateral or contralateral limb ataxia. We describe a patient with a pontomesencephalic tegmental infarction with hearing loss and hypogeusia as dominant features. A 52-year-old man had dizziness and loss of taste while eating dinner. The next morning upon awakening, he developed sensory changes of the left half of his face, clumsiness of the right arm and leg, and sensation of bilateral ear wadding. At admission, neurologic examination revealed right limb ataxia, decreased pinprick and touch sensation over the left half of his face, and bilateral hypoacusia, more marked on the left side. There was a marked diminution of taste on the left side of the tongue. His taste was examined by application of 0.5 M NaCl, 10% glucose, 0.2 M acetic acid, and 0.02 M quinine. The rest of the neurologic examination was normal. Limb ataxia and left face hypoesthesia gradually disappeared, and 10 days later only left tongue hypogeusia …