Sudden Onset Hearing Loss and Vertigo Just Before Posterior Inferior Cerebellar Artery Infarction (Lateral Medulla Syndrome)

Abstract

A 49-year-old woman presented with left-sided sudden hearing loss and tinnitus 1 (Day 1). Audiometric testing revealed a downsloping sensorineural hearing loss and 25% speech discrimination scores at 50 dBHL. She was diagnosed with left idiopathic sudden sensorineural hearing loss (SSNHL) and was managed with intravenous prednisolone administration (beginning at 60 mg/d).On Day 2, she experienced vertigo and, in the emergency department, was found to have a left-beating nystagmus with a torsional component and no other cerebellar signs or symptoms. On Day 6, she reported a worsening leftsided occipital headache. This was accompanied by mild ataxia, numbness of her right upper and lower extremities, FIG. 1. Magnetic resonance imaging (axial) 7 days (AYC) and 15 days after onset of SSNHL (DYF). A and D, T2-weighted imaging. B and E, Fluid attenuation inversion recovery. C and F, Diffusion-weighted imaging. An infarction of medulla (arrows) and cerebellum (arrowheads) are shown.

Sudden Hearing Loss with Vertigo Portends Greater Stroke Risk Than Sudden Hearing Loss or Vertigo Alone

“…24 However, other lines of evidence suggest a vascular etiology, including mechanisms (increase of prothrombin factors in patients with SHL 25 ) and an epidemiological association with stroke (history of stroke as a risk factor for SHL 26 and increased risk of stroke during 5-year follow-up [HR = 1.64] 11 ). Case reports and case series data suggest SHL can be a prodromal warning sign for a large-vessel disease (AICA infarction, 27 basilar artery occlusion, 28 or, rarely, even posterior inferior cerebellar artery [PICA] infarction 29 ). However, only 3% of AICA infarctions present initially with isolated SHL, compared with 60% with combined audiovestibular symptoms.…”

Hearing loss in lateral medullary syndrome

“…Furthermore, this infarction was mostly associated with the PICA lesion . A case with PICA infarction along with sudden‐onset hearing loss has been previously reported . Although the incidental comorbidity of the sudden sensorineural hearing loss on the side ipsilateral to the LMS cannot be disregarded, we speculate that the ischemia of the inner ear or the vestibulocochlear nerve as one of the most probable causes of the sudden sensorineural hearing loss might be compatible with the large ischemia suspected in the present case.…”

Sensorineural Hearing Loss Due to Vertebrobasilar Artery Ischemia-Illustrative Case and Literature Review

“…Previous cases presenting with sensorineural hearing loss without cranial nerve deficits in vertebrobasilar artery ischemia are shown in (Table 1) . Sensorineural hearing loss due to AICA syndrome is usually ipsilateral (88%) [6][7][8][9][10][11][12][13][14][15][16][17][18][19], whereas sensorineural hearing loss due to ischemia in the territory of the PICA is also ipsilateral but very rare [20,30]. Although SCA syndrome does not usually lead to hearing loss, contralateral hearing loss has been rarely reported [23,31].…”

“…Ischemia of the PICA does not typically result in auditory symptoms because the auditory pathway is not generally involved in the territory of the PICA [59]. However, sensorineural hearing has been reported to occur in the case of infarction in the territory of the PICA (PICA syndrome) in rare cases [20,30,31,60]. Lee found that only 1% of patients reported sudden deafness because of a non-AICA territory vertebrobasilar ischemic stroke [30].…”