Sudden Bilateral Sensorineural Hearing Loss due to Basilar Artery Occlusion (P3-5.027)

Abstract

<h3>Objective:</h3> We describe a case of a patient with occlusion of the basilar artery and bilateral anterior inferior cerebellar arteries (AICAs) who presented with a chief complaint of sudden bilateral sensorineural hearing loss (SNHL). <h3>Background:</h3> Sudden bilateral SNHL, defined as SNHL developing in less than 72 hours, is a rare phenomenon representing less than 5% of all acute SNHL cases. Whereas more frequent unilateral presentation is relatively benign, sudden bilateral SNHL represents a medical emergency and warrants immediate evaluation for life-threatening and/or reversible causes. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 56-year-old right-handed African American woman with personal medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, stroke, tobacco abuse, and obesity presented with sudden onset bilateral hearing loss preceded by one week of persistent vertigo and nausea. On admission she was hypertensive to 240/122 mm Hg, physical examination was significant for saccadic pursuit with spontaneous bilateral horizontal and vertical down-beating nystagmus, truncal ataxia, and bilateral SNHL confirmed by audiogram. CT of head alongside CT angiography showed occlusion of V4 segment of right vertebral artery extending through most of the basilar artery, and near-occlusion of bilateral AICAs. MRI showed late acute/early subacute ischemic infarcts in bilateral anterior cerebellum, cerebellar peduncles, and pons. Patient was out of time window for thrombolysis with rt-PA, mechanical thrombectomy was deferred due to &gt;24h from symptom onset and stable neurological examination throughout hospital admission. Blood pressure was gradually lowered and antiplatelet therapy with aspirin was initiated prior to discharge to rehabilitation facility. <h3>Conclusions:</h3> Sudden bilateral SNHL in isolation or accompanied by vestibular, cerebellar and/or brainstem signs particularly in patients with significant risk factors for cerebrovascular disease should alarm a clinician of a possibility of vertebrobasilar occlusion and prompt appropriate and timely medical management as delay in optimal medical treatment is associated with increased morbidity and mortality in this patient population. <b>Disclosure:</b> Dr. Buciuc has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Ali has nothing to disclose. Dr. Nankee has nothing to disclose. Dr. Holmstedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astrazeneca. The institution of Dr. Holmstedt has received research support from NIH. The institution of Dr. Holmstedt has received research support from Patient-Centered Outcomes Research Institute. The institution of Dr. Holmstedt has received research support from CSPC Pharmaceuticals . Dr. Holmstedt has received personal compensation in the range of $5,000-$9,999 for serving as a Study Adjudicator with Ischemia Care.