title: Missed Anterior Inferior Cerebellar Artery Aneurysm Mimicking Vestibular Neuritis-Clues to Prevent Misdiagnosis.
abstract: We discuss a case with combined vestibulocochlear and facial neuropathy mimicking a less urgent peripheral vestibular pattern of acute vestibular syndrome (AVS). With initial magnetic resonance imaging read as normal, the patient was treated for vestibular neuropathy until headaches worsened and a diagnosis of subarachnoid hemorrhage was made. On conventional angiography, a ruptured distal right-sided aneurysm of the anterior inferior cerebellar artery was diagnosed and coiled. Whereas acute vestibular loss usually points to a benign peripheral cause of AVS, combined neuropathy of the vestibulocochlear and the facial nerve requires immediate neuroimaging focusing on the cerebellopontine angle. Imaging should be assessed jointly by neuroradiologists and the clinicians in charge to take the clinical context into account.
authors.affiliation: Department of Neurosurgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Jan-Folkard
authors.initials: JF
authors.lastname: Willms
authors.affiliation: Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Baltsavias
authors.affiliation: Department of Neurosurgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Internal Medicine, Hospital Uster, Uster, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ernst
authors.affiliation: Department of Neurosurgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland. Electronic address: alexander.tarnutzer@usz.ch.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Tarnutzer
mesh_terms: D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D015901:Angiography, Digital Subtraction; D002531:Cerebellum / Q000098:blood supply*; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005155:Facial Nerve Diseases / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D018810:Magnetic Resonance Angiography; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D020338:Vestibular Neuronitis / Q000000981:diagnostic imaging*; D000160:Vestibulocochlear Nerve Diseases / Q000209:etiology
keywords: MRI; acute vestibular syndrome; aneurysm; anterior inferior cerebellar artery; diagnostic errors