Abstract
Labyrinthine infarction is a cause of acute audiovestibulopathy, but can be diagnosed only in association with other infarctions involving the brainstem or cerebellar areas supplied by the anterior inferior cerebellar artery (AICA) since current imaging techniques cannot visualize an infarction confined to the labyrinth. This case series aimed to establish embolic labyrinthine infarction as a mechanism of isolated acute audiovestibulopathy. We analyzed clinical features, imaging findings, and mechanisms of embolism in 10 patients (8 men, age range: 38-76) who had developed acute audiovestibulopathy in association with an obvious source of embolism and concurrent acute embolic infarctions in the non-anterior inferior cerebellar artery territories. The presence of audiovestibulopathy was defined when bedside or laboratory evaluation documented unilateral vestibular (head-impulse tests or caloric tests) or auditory loss (audiometry). Six patients showed combined audiovestibulopathy while three had isolated vestibulopathy. One patient presented isolated hearing loss. Audiovestibular findings were the only abnormalities observed in nine patients. In all patients, MRIs documented single or multiple infarctions in the cerebellum (n = 5) or cerebral hemispheres (n = 5). Especially three patients showed single or scattered foci of tiny acute infarctions only in the cerebral hemispheres. Cardiac sources of embolism were found in eight, and artery-to-artery embolism was presumed in two patients. Selective embolism to the labyrinth may be considered in patients with acute unilateral audiovestibulopathy and concurrent acute infarctions in the non-AICA territories.
Highlights
Even though acute vertigo or hearing loss may occur due to an infarction involving the labyrinth [1], current imaging techniques do not readily allow identification of isolated labyrinthine infarctions as a cause of acute audiovestibulopathy [2]
Since the labyrinth is supplied by the internal auditory artery (IAA) that mostly stems from the anterior inferior cerebellar artery (AICA) [3, 4], labyrinthine infarction is usually accompanied by infarctions involving the brainstem and cerebellar structures
Sudden deafness with or without caloric canal paresis may occur in association with infarctions involving the cerebellum or brainstem of non-anterior inferior cerebellar artery territory, and the sudden deafness in these cases were explained by a dominant posterior inferior cerebellar artery (PICA) supplying the labyrinth or a relative ischemic vulnerability of the labyrinth [8]
Summary
Even though acute vertigo or hearing loss may occur due to an infarction involving the labyrinth [1], current imaging techniques do not readily allow identification of isolated labyrinthine infarctions as a cause of acute audiovestibulopathy [2]. Sudden deafness with or without caloric canal paresis may occur in association with infarctions involving the cerebellum or brainstem of non-anterior inferior cerebellar artery (non-AICA) territory, and the sudden deafness in these cases were explained by a dominant posterior inferior cerebellar artery (PICA) supplying the labyrinth or a relative ischemic vulnerability of the labyrinth [8]. The senior author has experienced occasional consultations regarding the patients who developed acute vertigo or hearing loss in association with the imaging findings of acute embolic infarctions in the distant non-AICA territories. The most probable mechanism would be a separate embolism to the labyrinth, which is not visualized with current imaging techniques
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