Introduction: Sudden bilateral deafness and facial weakness are unusual presentations of brain stem stroke.
Observation: We report the case of a patient who presented successively sudden bilateral deafness and facial diplegia in correlation with a brain stem stroke but without any ischemic pontine lesion.
Discussion: Unlike our case, all of the earlier publications, have reported the presence of ischemic pontine lesions in patients with bilateral deafness and facial diplegia. Selective vulnerability of inner ear to ischemia has been hypothesized but cannot explain the facial diplegia.
Conclusion: Our case would suggest extra-neuraxis failure by ischemia of the acoustico-facial nerve.