Objective:

To highlight the importance of recognizing acute audiovestibular loss as a potential early sign of AICA infarction and the need for prompt neuroimaging in high-risk patients.

Background:

Acute audiovestibular loss, commonly attributed to peripheral causes like labyrinthitis, can also result from ischemia in the anterior inferior cerebellar artery (AICA) territory. Recognizing this presentation is critical for identifying posterior circulation stroke, particularly in patients with significant vascular risk factors.

Design/Methods:

We present the case of a 71-year-old African American male with poorly controlled hypertension, hyperlipidemia, and smoking, who presented with two weeks of right-sided hearing loss followed by two days of unsteady gait. Neuroimaging, including CTA and MRI, was used to evaluate the etiology of his symptoms. The diagnostic approach, imaging findings, and management are discussed.

Results:

CTA showed 70% stenosis of the basilar artery with occlusion of the right AICA. MRI confirmed a small infarct in the right ventral pons and multiple cerebral microbleeds. The patient was diagnosed with AICA infarction secondary to large vessel atherosclerosis. Given the considerable risk of hemorrhage due to cerebral microbleeds, aspirin monotherapy was started, along with statin therapy for dyslipidemia.

Conclusions:

This case underscores the need to consider AICA infarction in patients presenting with acute audiovestibular loss, particularly those with vascular risk factors. Early neuroimaging is essential to avoid misdiagnosis. Management strategies should balance the risks of ischemic recurrence and hemorrhagic complications in patients with concurrent microvascular pathology.