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Acute hearing symptoms as a prodrome of anterior inferior cerebellar artery infarction
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Hyung Lee, Yong Won Cho, Sung Il Sohn
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J Korean Bal Soc. 2003;2(1):95-102.
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 Abstract
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- Objectives
An acute auditory symptom (AAS) without any other neurological symptoms or signs suggests a lesion in the peripheral auditory system. Blood supply to the peripheral auditory system arises from the internal auditory artery, ordinarily a branch of the anterior inferior cerebellar artery (AICA), therefore a partial ischemia in the AICA distribution may manifest with an AAS and/or vertigo. The aim of this study was to investigate the clinico-radiologic features of patients who presented with an AAS as a prodromal symptom of the AICA infarction.
Methods
Sixteen consecutive cases of the AICA infarction diagnosed by brain MRI completed a standardized audiovestibular questionnaire and underwent a neurotological evaluation by an experienced neurotologist.
Results
Five patients (31%) had an AAS as a prodrome of the AICA infarction 1-10 days prior to onset of other brainstem and/or cerebellar symptoms. Two types of AAS were found: recurrent transient hearing loss and/or tinnitus (n=3) or a single episode of prolonged hearing loss and/or tinnitus (n=2). The episodic symptoms were brief, lasting only minutes. The tinnitus preceding infarction was identical to the tinnitus experienced at the time of infarction. At the time of the infarction, all patients developed hearing loss, tinnitus, vertigo, and an ipsilateral hemiataxia. The most common affected site was the middle cerebellar peduncle (n=5). Four of 5 patients had an incomplete hearing loss and all patients had an absence of vestibular function to caloric stimulation on affected side, respectively.
Conclusions
AAS may be a warning sign of an impending pontocerebellar infarction in the distribution of the AICA. The AAS preceding an AICA infarction may result from an ischemia of the inner ear or the vestibulocochlear nerve.
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Migraine and idiopathic recurrent vertigo
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Hyung Lee, Sung Il Sohn, Yong Won Cho
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J Korean Bal Soc. 2002;1(2):240-244.
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Abstract
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- Background
and Objectives: Chronic recurrent attacks of vertigo, not associated with any auditory or neurological symptoms, are a common reason for referral to our neurotology clinic. Even after an extensive neurotological evaluation, some cases remain undiagnosed. We have performed this study to assess the prevalence of migraine in patients with idiopathic isolated recurrent vertigo as compared with controls, and to identify the clinical features and abnormalities of vestibular testing in patients with isolated recurrent vertigo. Materials and methods: We prospectively evaluated 72 consecutive patients who presented to the clinic with isolated recurrent vertigo of unknown cause. All patients underwent diagnostic evaluation to exclude identifiable causes of isolated recurrent vertigo. We compared the prevalence of migraine, according to the International Headache Society (IHS) criteria, in the isolated recurrent vertigo group, with a sex- and age-matched control group of orthopaedic patients. Results: The prevalence of migraine according to IHS criteria was higher in the isolated recurrent vertigo group (61.1 %) than in the control group (10 %; p<0.01). Only 16.7 % of patients had an abnormal vestibular function test. The most common abnormal finding was a unilateral vestibular weakness to caloric stimulation. Conclusions: Our results suggest that migraine should be considered in the differential diagnosis of isolated recurrent vertigo of unknown cause.
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Sudden Deafness and Anterior Inferior Cerebellar Artery Infarction
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Hyung Lee, Sung Il Sohn, Doo Kyo Jung, Yong Won Cho, Jeong Geung Lim, Sang Doe Yi
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J Korean Bal Soc. 2002;1(1):124-131.
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Abstract
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- Background
and objectives : Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness, and gait ataxia. There have been few reports on deafness associated with the AICA infarction. Furthermore, previous neurological reports have not emphasized the inner ear as a localization of sudden deafness. The aim of this study was to investigate the incidence of deafness associated with the AICA infarction and the sites predominantly involved in deafness.
Materials and method : During two years we prospectively identified 12 consecutive patients with unilateral AICA infarction diagnosed by brain MRI. Pure tone audiogram, speech discrimination testing, stapedial reflex testing, and auditory brainstem responses were performed to localize the site of lesion in the auditory pathways. Electronystagmography was also performed to evaluate the function of the vestibular system.
Results
: The most common affected site on brain MRI was the middle cerebellar peduncle (11). Four patients had vertigo and/or acute auditory symptoms such as hearing loss or tinnitus as an isolated manifestation from 1day to 2months prior to infarction. Audiological testings confirmed sensorineural hearing loss in 11 (92%) patients, predominantly involved the cochlea in 6 and retrocochlear in 1. The other 4 patients had a severe to profound hearing loss most likely of cochlear origin. Electronystagmography demonstrated no response to caloric stimulation in 10(83%) patients.
Conclusions
: In our series, sudden deafness was an important sign for the diagnosis of the AICA infarction. Audiological examinations suggest that sudden deafness in AICA infarction is usually due to dysfunction of the cochlea, resulting from ischemia to the inner ear.
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KBS
