Objective:

We present a case of bilateral AICA territory stroke secondary to vertebral artery dissection, manifesting as sudden-onset bilateral hearing loss.

Background:

Acute ischemic stroke involving the anterior inferior cerebellar artery (AICA) is rare, comprising only about 1.4% of all ischemic cerebellar strokes. Clinical presentations typically include vertigo, ataxia, hearing loss, nystagmus, and nausea or vomiting. Reports of vertebral artery dissection associated with bilateral sensorineural hearing loss are uncommon, and cases documenting bilateral cerebellar hemispheric and pontine infarcts in patients with sudden-onset bilateral sensorineural hearing loss are even rarer.

Design/Methods:

A 44-year-old male with no significant medical history presented to our hospital with acute bilateral hearing loss following severe neck pain that developed after shoveling snow. A CT angiogram revealed a dominant left vertebral artery, a right vertebral artery dissection, and a left vertebral artery dissection at the C3 level. Diffusion-weighted imaging showed multiple scattered acute infarcts in both cerebellar hemispheres, along with a small acute infarct in the left pons. He was treated with dual antiplatelet therapy (Aspirin and Plavix) for 90 days, followed by aspirin monotherapy. A repeat CT angiogram 3 weeks after the initial event confirmed a hypoplastic right vertebral artery and a dominant left vertebral artery. A subsequent CT angiogram 2 months later indicated a healed dissection. The patient’s hearing fully returned to baseline within 1 month of symptom onset.

Results:

N/A

Conclusions:

Sudden-onset bilateral sensorineural hearing loss is a rare but important clinical finding in patients with acute AICA territory infarction, particularly in the context of vertebral artery dissection.