Sudden Unilateral Sensorineural Hearing Loss and Vertigo as a Presentation of Pontine Infarct: A Case Report
Tarin Tanji1, Riana Schleicher1, Alejandro Vargas2, Michelle Sweet2
1Rush Medical College, 2Rush University Medical Center
Objective:
To describe the diagnostic considerations and management for a patient with sudden unilateral sensorineural hearing loss (SSNHL) and vertigo.
Background:
SSNHL is most commonly idiopathic or due to primary otologic pathology. Vertigo may accompany SSNHL due to concurrent inner ear involvement. When SSNHL and vertigo occur alongside focal neurologic symptoms (e.g., diplopia, dysarthria, ataxia), central nervous system (CNS) pathology should be considered, particularly vertebrobasilar ischemia. However, the absence of such symptoms does not exclude CNS etiology. We present a case of a postoperative SSNHL and vertigo without additional neurologic deficits.
Results:
A 54-year-old female with renovascular hypertension, type 2 diabetes, and left renal artery stenosis, underwent left renal artery angioplasty and stenting. On awakening from anesthesia, she developed acute left-sided hearing loss, vertigo, and nausea, without other focal neurologic deficits. ENT evaluation and audiogram confirmed left-sided SSNHL.
Initial MRI of the internal auditory canals was unremarkable. She started a guideline-based prednisone taper for idiopathic SSNHL.
On hospital day 9, due to persistent symptoms, MRI revealed a punctate acute infarct in the left ventral paramedian pons with subtle T2 hyperintensity; MRA demonstrated bilateral carotid atherosclerosis and mild-to-moderate basilar artery stenosis. She was started on aspirin and high-intensity statin therapy and referred to stroke follow-up.
Conclusions:
SSNHL with vertigo, even without other focal neurological deficits, can signal posterior circulation stroke. Although the vascular etiology was central (pontine infarct and mid-basilar stenosis), the hearing loss is most consistent with a peripheral cause: cochlear ischemia from AICA hypoperfusion due to blood pressure fluctuations. The pontine infarct is localized to the corticospinal tracts, and may represent a bystander lesion and a surrogate marker of hypoperfusion, rather than the cause of hearing loss. Clinicians should maintain a broad differential for SSNHL, including both peripheral and central causes.
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