Central auditory processing disorder as the presenting manifestation of subtle brain pathology.

The objective of this case-report study was to assess the presence of central auditory impairment in a patient with a normal neurological examination. This subject was a 45-year-old female with gradually deteriorating hearing difficulties over a period of 5 years and a borderline normal audiogram. Behavioural central auditory tests were used, including Dichotic Sentence Identification Test, Competing Sentences Test, and auditory event-related potentials (mismatch negativity). Behavioural central auditory tests and mismatch negativity results were abnormal and indicated disordered central auditory processing. Subsequent magnetic resonance imaging of the brain identified subtle changes consistent with small-vessel ischaemic disease. Adult patients who present with hearing difficulties that cannot be explained on the basis of their audiogram should undergo central auditory assessment, as the auditory symptoms may be the first and only manifestation of central nervous system pathology.