Diagnostic challenge: Subacute infarction of the anterior inferior cerebellar artery (AICA) – A case-report
23 April 2019 (online)
Given the prevalence of acute vestibular disorders with a broad range of symptoms, the differentiation of central from peripheral disorders is always a challenge, especially as the former can potentially yield a life-threatening course. In the following, we present the case of an infarction of the inferior anterior cerebellar artery (AICA).
We report on a 70-year-old man with type II diabetes mellitus, who was referred to our department for 4 days due to balance problems and an acute hearing loss on the left side. He complained of a sudden exacerbation of his initial complaints and nausea under oral steroid therapy. Head impulse test (HIT) showed pathological saccades in the plane of all semicircular canals on the left side. The remaining HINTS (HIT plus lateral gaze nystamus and skew deviation) were negative. We found a sensorineural hearing loss on the left side of 40 to60dB. In addition, the patient complained of paraesthesia of the left angle of mouth.
Initial examination was followed by an emergency neurological consultation. In the meantime, the patient developed dysarthria, ataxia when performing the finger-nose test on the left and a slight facial palsy on the left. An arterial angio-MRI of the cerebrum showed a fresh infarction of the cerebellar peduncle in the AICA tract on the left. Further diagnostics showed a previously untreated atrial fibrillation and arterial hypertension.
In the case of acute onset of vertigo with hearing loss, AICA-infarction should also be considered, especially in patients with cardiovascular risk factors. Minor paraesthesias, dysarthria or dysmetria indicate a possible central nervous lesion which should lead to a swift neurological work-up.