Isolated labyrinthine infarction as a harbinger of anterior inferior cerebellar artery territory infarction with normal diffusion-weighted brain MRI

Abstract

Objectives This paper aims to determine the frequency of isolated labyrinthine infarction as an initial manifestation of anterior inferior cerebellar artery (AICA) territory infarction and discuss its clinical implication. Methods We studied 54 consecutive patients with AICA infarction diagnosed by brain MRI from the acute stroke registry. Results We identified 4 patients (7.4%) with AICA territory infarction who initially presented with vertigo and hearing loss mimicking acute labyrinthitis and subsequently suffered from delayed neurological deficits. All patients had normal brain MRIs including diffusion-weighted images at the time of isolated audiovestibular loss, but all subsequently exhibited acute infarct(s) in the AICA territory on follow-up brain MRIs when they developed additional neurological deficits. Conclusion Labyrinthine infarction may be a warning sign of impending pontocerebellar infarction in the AICA territory. Our results indicate that even a classical peripheral presentation, e.g., acute hearing loss, and acute vertigo with unidirectional nystagmus, may be a manifestation of ischemic stroke in the posterior circulation.