Introduction:
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).
Case report:
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.
Conclusion:
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.
