Thrombosis of the basilar artery--a rare differential sudden deafness diagnosis and vestibular failure

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Occlusion of basilar artery is a rare and life-threatening event. A quick and safe diagnosis and initiation of adequate therapy are decisive. For the ENT-specialist it is important to know that this thrombosis, which runs a lethal course in many cases, can develop with a disturbance of hearing and/or vestibular function as initial symptoms. Reported are four cases of thrombosis of the basilar or vertebral artery. Two out of four patients contacted the ENT emergency unit because of symptoms of acute vestibular neuritis, one patient was previously diagnosed with sudden deafness by a local ENT-specialist, one patient was treated for hypertension induced epistaxis in one of our wards. Only one patient initially presented additional neurological symptoms, causing suspicion for a brainstem lesion as well. However these symptoms were only noticed on close examination. By immediate anticoagulation therapy (with Heparin) progress of thrombosis could be avoided. The patient showed a complete recovery and was free of any symptoms two years after thrombosis. Two of the other two patients developed a delayed onset of neurological symptoms next to the initial symptoms of vestibular and cochlear affection (within 24 hours), therefore diagnosis of thrombosis was late and despite of immediate anticoagulation therapy (with Heparin) both patients died. The one patient treated for hypertension induced epistaxis developed only discrete symptoms of basilar artery thrombosis, nevertheless he was diagnosed and treated immediately. He made a complete recovery and was dismissed two weeks later. It is therefore necessary to carefully control and sometimes correct diagnosis in cases of sudden deafness and acute vestibular neuritis. Especially additional neurological symptoms indicate the necessity of a MRI-angiogram or CT-(angiography)scan to exclude thrombosis of the basilar artery.