Progression of acute cochleovestibulopathy into anterior inferior cerebellar artery infarction.
Antemortem diagnosis of isolated inner ear infarction remains a diagnostic challenge since current imaging techniques do not permit differentiation of isolated labyrinthine infarction from other more benign disorders involving the inner ear. An 81-year-old woman with diabetes, hypertension and hypercholesterolemia presented with vertigo and hearing loss. Initial examination revealed findings of left cochleovestibular labyrinthitis without brainstem or cerebellar signs. MRIs including the diffusion-weighted images were normal. Five days later, however, she developed dysarthria, and decreased facial sensation, subtle facial palsy, and dysmetria in the left side. Follow-up MRI was consistent with acute infarctions in the territory of anterior inferior cerebellar artery (AICA), involving the left lateral pons, left middle cerebellar peduncle, and inferolateral cerebellum. AICA infarction should be considered in acute audiovestibular syndrome, especially in aged patients with vascular risk factors, even though the classic brainstem or cerebellar signs are absent.
Lee
Hyung
H
Department of Neurology, Keimyung University School of Medicine, Republic of Korea.
Kim
Hyo-Jung
HJ
Koo
Ja-Won
JW
Kim
Ji Soo
JS
D000208:Acute Disease; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D020520:Brain Infarction / Q000175:diagnosis* / Q000209:etiology; D002531:Cerebellum / Q000098:blood supply* / Q000503:physiopathology; D015834:Cochlear Diseases / Q000175:diagnosis* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005071:Evoked Potentials; D005123:Eye / Q000473:pathology / Q000503:physiopathology; D005133:Eye Movements; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D018810:Magnetic Resonance Angiography; D018482:Muscle, Skeletal / Q000502:physiology; D020338:Vestibular Neuronitis / Q000175:diagnosis* / Q000503:physiopathology