Case Report: Mixed-Cause Vertigo and Sudden Sensorineural Hearing Loss as Presentations of Vertebrobasilar Dolichoectasia

Abstract

Sudden sensorineural hearing loss (SSNHL) is a syndrome characterized by rapid progression of hearing impairment over seconds to days. While no universally accepted definition exists, it is often defined as a sensorineural hearing loss of 30 decilbles (dB) or more across at least three contiguous frequencies, occurring within 72 hours.In elderly patients and those with vascular risk factors who develop SSNHL, ischemia of the vertebrobasilar territory is suspected, especially of the anteroinferior cerebellar artery. This is because ischemia that affects this artery produces 79% of SSNHL associated with cerebral infarction. In many cases of ischemia of the vertebrobasilar territory, there is an association with anomalies of the vertebrobasilar circulation, such as vertebral artery hypoplasia or vertebrobasilar dolichoectasia.Here, we report a case of a 73-year-old man who presented right sudden hearing loss accompanied by acute onset vertigo, a physical exploration compatible with right vestibular dysfunction, and a history of recurrent episodes of syncope in the context of vertebrobasilar dolichoectasia, as diagnosed via magnetic resonance imaging (MRI).

Vertebrobasilar and Basilar Dolichoectasia Causing Audio-Vestibular Manifestations: A Case Series with a Brief Literature Review

“…MRI was performed for all cases. VBD [8,9,[16][17][18] was more frequently reported than BD [6] with 85 cases vs. 5 cases, respectively. Smoker's classification was applied in only one study [4] to quantify dolichoectasia; the other studies used different methods to report the alterations in the posterior circulation vessels (see Table 2).…”

“…Following our research methods, 487 manuscripts were retrieved from the PubMed and Scopus databases from January 2000 to March 2022 (see also Figure 4). Seven articles [4,6,9,[16][17][18][19] were included in the present study, according to inclusion/exclusion criteria. Table 2 summarizes the results of this review.…”

“…Considered patients generally developed mild to moderate hearing loss, without significant alterations of speech recognition [4,6,9,16]. When ABRs were performed, augmented latencies of I-V and III waves were recorded [9,19].…”

“…When ABRs were performed, augmented latencies of I-V and III waves were recorded [9,19]. Vestibular assessment tools included Dix-Hallpike test, caloric test, VNG, head impulse test (HIT), and head shaking Test (HST) [4,9,[16][17][18]. MRI was performed for all cases.…”