Anterior Inferior Cerebellar Artery Infarction Research Articles

Korean Medicine Treatment for Anterior Inferior Cerebellar Artery Infarction: A Case Report

Objective: The aim of this study is to report the effectiveness of Korean medicine for a patient with dizziness following anterior inferior cerebellar artery infarction.Methods: The patient was treated with traditional Korean methods including acupuncture, herbal therapy, moxibustion, and vestibular rehabilitation exercise during an admission period of seven days. The patient’s dizziness was assessed using a numeric rating scale (NRS) and the Korean Dizziness Handicap Inventory (K-DHI), Korean Activities-specific Balance Confidence (K-ABC), Korean Vestibular Disorders Activities of Daily Living (K-VADL), the modified Rankin scale (mRS), and the Korean version of the Modified Barthel Index (K-MBI).Results: After seven days of combined treatment with traditional methods and vestibular rehabilitation, the patient’s dizziness was reduced from NRS 6-7 to NRS 2. In addition, K-DHI decreased from 84 to 22; K-ABC improved from 52% to 78.125%; K-VADL reduced from 175 to 37; the mRS score changed from 4 to 1; and the K-MBI score increased from 86 to 98. No adverse events were observed during treatment.Conclusion: This study suggests that combined therapy of Korean medicine and vestibular rehabilitation can be effective treatment for anterior inferior cerebellar artery infarction patients.

Anterior Inferior Cerebellar Artery Infarct Presenting as Unilateral Deafness in a Young Patient

Acute ischemic stroke in the supply of the anterior inferior cerebellar artery is known to be connected with facial weakness, nystagmus, hearing loss, hypalgesia, and ataxia. This is a case of a young man with unilateral deafness caused due to infarction of anterior inferior cerebellar artery. Clinical findings and audiometry showed evidence suggestive of cochlear localization for deafness. MRI (Magnetic resonance imaging) Brain shows involvement of pons with infarct is seen in the right Anterior inferior cerebellar artery (AICA) territory. The inclusion of labyrinthine auditory artery suggests sensorineural hearing loss.

Sudden unilateral hearing loss and vertigo due to posterior inferior cerebellar artery territorial hypo perfusion by vertebral artery dissection

Sudden hearing loss and vertigo are the typical presentation of anterior inferior cerebellar artery infarction, but may occur in posterior inferior cerebellar artery (PICA) infarction. However, it is known that it is very rare that hearing loss and vertigo occur due to perfusion deficits without the occurrence of infarction. Here I describe a patient who presented with sudden hearing loss in left ear and vertigo due to PICA territorial hypo perfusion without infarction by vertebral artery (VA) dissection.

Case report: the etiology of anterior inferior cerebellar artery infarction: what does basi-parallel anatomic scanning magnetic resonance imaging tell us?

BackgroundThe precise etiology of anterior inferior cerebellar artery (AICA) infarction is difficult to identify because of the high anatomic variability of vertebrobasilar arteries and the limitations of conventional vascular examinations. Basi-parallel anatomic scanning magnetic resonance imaging (BPAS-MRI) can reveal the outer contour of the intracranial vertebrobasilar arteries, which may be helpful to distinguish the arteriosclerosis from congenital dysplasia and dissection.Case presentationIn this study, we reported 3 cases of AICA infarction and discussed the diagnostic value of BPAS-MRI in the evaluation of vascular etiology.ConclusionsThe BPAS-MRI could be considered as an important supplementary in the diagnosis of vascular etiology of infarction in AICA territory.

Double adjacent basilar artery fenestration with cerebellar infarct: Case report and new classification of double basilar fenestrations

Basilar artery (BA) fenestration is an uncommon congenital variant associated with aneurysms and posterior circulation infarcts. We present a 42-year-old male, smoker and hypertensive who came with acute onset vertigo and gait ataxia. Cerebellar signs were positive on the left side. Diffusion-weighted brain magnetic resonance imaging showed acute infarct in the left anterior inferior cerebellar artery (AICA) territory. Computed tomography angiography showed BA double adjacent fenestration of proximal segment of BA, without thrombus, dissection/aneurysm. To the best of our knowledge, only three cases of double adjacent BA fenestration have been described so far. The association between vertebro-BA fenestrations and posterior circulation stroke is controversial. It has been suggested that turbulent flow at the site of fenestration predisposes to thrombus formation, which may be cause of stroke. This rare anatomic variant of the posterior circulation is important to recognize and may have associated neurologic consequences (double BA fenestrations are rare yet known congenital variants associated with aneurysms and associated neurological implications) (double adjacent BA fenestration presenting with AICA infarct are still rarer with only three cases reported across the world).

Feasibility of magnetic resonance imaging in the differential diagnosis of isolated acute audiovestibular loss.

Isolated acute audiovestibular loss is characterized by the sudden onset of unilateral hearing loss and prolonged vertigo. The purpose of this study is aimed to identify the value of magnetic resonance imaging (MRI) for the evaluation of isolated acute audiovestibular loss. We retrospectively enrolled 31 patients with isolated acute audiovestibular loss from March 2007 to December 2017. Specific medical records including initial and final pure tone audiometry (PTA), and canal paresis value were reviewed. Abbreviated MRI was performed in all patients. Fifteen patients showed increased signal of labyrinth on FLAIR images and eleven revealed negative findings on MRI. Two patients showed an infarction in the anterior inferior cerebellar artery (AICA) territory and three exhibited vestibular schwannoma in the internal auditory canal. There were no significant differences in initial, final PTA, and hearing recovery between negative and labyrinthine abnormality groups on MRI. Our results show that isolated acute audiovestibular loss due to labyrinthitis is more common than other secondary causes including vestibular schwannoma or AICA infarction. However, MRI with a tailored, abbreviated protocol is strongly recommended in patients with isolated acute audiovestibular loss to identify the exact etiologies.

Trigeminal trophic syndrome following anterior inferior cerebellar artery infarction

A 70-year-old woman with hypertension presented about 3 months ago with complaints of dysarthria, left lower motor neuron facial palsy with preserved Bell’s phenomenon, sensory loss over the left side...

Central vertigo.

This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology. Strokes presenting dizziness-vertigo are more likely to be associated with a misdiagnosis in the emergency setting. The risk of future strokes after discharge is higher in patients diagnosed with peripheral vertigo than in control patients. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome. Diagnosis of acute combined central and peripheral vestibulopathy such as anterior inferior cerebellar artery infarction requires additional consideration whenever applying the HINTS (head impulse test, direction-changing gaze-evoked nystagmus, and test of skew). Heat illness and metronidazole have been recognized as new causes of central vestibulopathy. Some new findings have also been added to the clinical and laboratory features of central vertigo. Central vertigo is a heterogeneous group of disorders with diverse clinical spectrums. An integrated approach based on understanding of clinical features, laboratory findings, speculated mechanisms, and limitations of current diagnostic tests will lead to better clinical practice.

Sudden Hearing Loss Due to Anterior Inferior Cerebellar Artery Infarction.

Sudden Hearing Loss Due to Anterior Inferior Cerebellar Artery Infarction.

Clinical Study of Seven Patients with Infarction in Territories of the Anterior Inferior Cerebellar Artery

The prominent features of anterior inferior cerebellar artery (AICA) infarction are vertigo, cerebellar ataxia, and impaired hearing. The present study investigated neurological characteristics associated with AICA infarction. The locations of infarcts in 7 patients (age, 32-72 years) with AICA infarction were divided into the lower lateral pons, the middle cerebellar peduncle (MCP), and the cerebellum. Ischemic lesions were located in the MCP in 6 patients, spread to the lower lateral pons in 3, and involved the cerebellum in 4 patients. Standing posture and gait were impaired in all patients. Five and 4 patients had impaired hearing and vertigo, respectively. Two patients had only symptoms of labyrinthine disease, and 1 had these symptoms accompanied by impaired hearing. The symptoms in 2 patients with the lesion in the lateral pons were consistent with those in Gasperini syndrome. Two of 3 patients without vertigo had ataxia of the extremities. Stenosis of the vertebral artery or basilar artery in 5 patients indicated that the etiology was branch atheromatous disease. The most prominent symptom of truncal and gait ataxia and the frequent association between vertigo and impaired hearing were consistent with the characteristics of AICA infarction. Two patients without vertigo had ataxia of the trunk and extremities that might have been due to involvement of the dorsal spinocerebellar tract in the inferior cerebellar peduncle.

Vertigo with sudden hearing loss: audio-vestibular characteristics.

Acute vertigo with sudden sensorineural hearing loss (SSNHL) is a rare clinical emergency. Here, we report the audio-vestibular test profiles of 27 subjects who presented with these symptoms. The vestibular test battery consisted of a three-dimensional video head impulse test (vHIT) of semicircular canal function and recording ocular and cervical vestibular-evoked myogenic potentials (oVEMP, cVEMP) to test otolith dysfunction. Unlike vestibular neuritis, where the horizontal and anterior canals with utricular function are more frequently impaired, 74% of subjects with vertigo and SSNHL demonstrated impairment of the posterior canal gain (0.45±0.20). Only 41% showed impairment of the horizontal canal gains (0.78±0.27) and 30% of the anterior canal gains (0.79±0.26), while 38% of oVEMPs [asymmetry ratio (AR)=41.0±41.3%] and 33% of cVEMPs (AR=47.3±41.2%) were significantly asymmetrical. Twenty-three subjects were diagnosed with labyrinthitis/labyrinthine infarction in the absence of evidence for an underlying pathology. Four subjects had a definitive diagnosis [Ramsay Hunt Syndrome, vestibular schwannoma, anterior inferior cerebellar artery (AICA) infarction, and traction injury]. Ischemia involving the common-cochlear or vestibulo-cochlear branches of the labyrinthine artery could be the simplest explanation for vertigo with SSNHL. Audio-vestibular tests did not provide easy separation between ischaemic and non-ischaemic causes of vertigo with SSNHL.

Ischemia as a potential etiologic factor in idiopathic unilateral sudden sensorineural hearing loss: Analysis of posterior circulation arteries

The association between idiopathic sudden sensorineural hearing loss (ISSNHL) and the radiologic characteristics of the vertebrobasilar artery is unclear. We hypothesized that the degree and direction of vertebrobasilar artery curvature in the posterior circulation contribute to the occurrence of ISSNHL. We consecutively enrolled patients diagnosed with unilateral ISSNHL in two tertiary hospitals. Magnetic resonance images were performed in all patients to exclude specific causes of ISSNHL, such as vestibular schwannoma, chronic mastoiditis, and anterior inferior cerebellar artery infarct. We measured the following parameters of posterior circulation: vertebral and basilar artery diameter, the degree of basilar artery curvature (modified smoker criteria), and vertebral artery dominance. Pure tone audiometries were performed at admission and again 1 week and 3 months later. A total of 121 ISSNHL patients (mean age, 46.0 ± 17.3 years; 48.8% male) were included in these analyses. The proportion of patients with the left side hearing loss was larger than the proportion with the right side hearing loss (left, 57.9%; right, 42.1%). The majority of patients were characterized by a left dominant vertebral artery and right-sided basilar artery curvature. The direction of the basilar artery curvature was significantly associated with hearing loss lateralization (p = 0.036). Age and sex matched multivariable analyses revealed the absence of diabetes and right-sided basilar artery curvature as significant predictors for left sided hearing loss. There was no statistical difference between atherosclerotic cardiovascular risk score (high versus low) and hearing outcomes at 3 months. In ISSNHL, the laterality of hearing loss was inversely associated with the direction of basilar artery curvature. Our results, therefore, indicate the importance of vascular assessment when evaluating ISSNHL.

Wallenberg's lateral medullary syndrome with facial palsy caused by anterior inferior cerebellar artery infarct

Wallenberg's lateral medullary syndrome with facial palsy caused by anterior inferior cerebellar artery infarct

48 Years Old Patient Bilateral Sudden Sensorineural Hearing Loss Occurred in Order: Correlation of Hearing loss with Obstruction of Anterior Inferior Cerebellar Artery and Probability of Collateral Circulation of Cochlea.

He lost suddenly right hearing 2 months ago, but he didn't his sudden sensori neural hearing loss (SSNHL). He had left SSNHL 1 day ago, he visited Jeju National University Hospital. He only complained of hearing loss. In pure tone audiometry (PTA), his hearing was measured 62dB/24% at right side and 87dB/0% at left side respectively. The magnetic resonance image (MRI) and angiography (MRA) of the brain showed total occlusion of right internal carotid artery and both anterior inferior cerebellar artery (AICA) was invisible in MRA. There was no AICA infarction in diffusion image of brain MRI. We treated him with high dose methylprednisolone, intratympanic dexamethasone injection (ITDI), IV alprostadil 10pg, ginkobiloba, pentoxifyline and aspirin. In addition, we detected hypertension (HTN) and diabetes mellitus (DM) and treated diseases with department of internal medicine. After treatment for 2 months brain MRI and MRA showed more abundant collateral circulation of brain than initial MRA.But both AICA was invisible. After treatment for 4 months his left hearing was measured 30dB/90% at left side in PTA.

Gravity-dependent Nystagmus and Inner-Ear Dysfunction Suggest Anterior and Posterior Inferior Cerebellar Artery Infarct

Cerebellar lesions may present with gravity-dependent nystagmus, where the direction and velocity of the drifts change with alterations in head position. Two patients had acute onset of hearing loss, vertigo, oscillopsia, nausea, and vomiting. Examination revealed gravity-dependent nystagmus, unilateral hypoactive vestibulo-ocular reflex (VOR), and hearing loss ipsilateral to the VOR hypofunction. Traditionally, the hypoactive VOR and hearing loss suggest inner-ear dysfunction. Vertigo, nausea, vomiting, and nystagmus may suggest peripheral or central vestibulopathy. The gravity-dependent modulation of nystagmus, however, localizes to the posterior cerebellar vermis. Magnetic resonance imaging in our patients revealed acute cerebellar infarct affecting posterior cerebellar vermis, in the vascular distribution of the posterior inferior cerebellar artery (PICA). This lesion explains the gravity-dependent nystagmus, nausea, and vomiting. Acute onset of unilateral hearing loss and VOR hypofunction could be the manifestation of inner-ear ischemic injury secondary to the anterior inferior cerebellar artery (AICA) compromise. In cases of combined AICA and PICA infarction, the symptoms of peripheral vestibulopathy might masquerade the central vestibular syndrome and harbor a cerebellar stroke. However, the gravity-dependent nystagmus allows prompt identification of acute cerebellar infarct.

Head-Shaking Aids in the Diagnosis of Acute Audiovestibular Loss due to Anterior Inferior Cerebellar Artery Infarction

Objective: To determine the patterns and diagnostic value of head-shaking nystagmus (HSN) in patients with acute audiovestibular loss. Method: Eighteen patients underwent evaluation of spontaneous nystagmus, gaze-evoked nystagmus, HSN, head impulse test, ocular tilt reaction, subjective visual vertical, bithermal caloric tests, and pure-tone audiogram. The findings were compared with those of 21 patients with labyrinthitis. Results: Fifteen patients (83%) exhibited HSN, and the horizontal HSN usually beat contralesionally (10/14, 71%). However, 9 (50%) patients also showed patterns of central HSN that included perverted HSN (n = 7), HSN in the opposite direction of spontaneous nystagmus (n = 4), and HSN beating towards unilateral canal paresis or abnormal head impulse testing (n = 3). Overall, central HSN, gaze-evoked nystagmus, and normal head impulse testing were specific for anterior inferior cerebellar artery (AICA) infarction. Moreover, central HSN was the only sign that indicated stroke in 1 of our patients with isolated audiovestibular syndrome. Lesion subtraction analyses revealed that damage to the flocculus was relatively frequent in patients with perverted HSN. Conclusions: In AICA infarction, HSN was common with both peripheral and central patterns. Careful evaluation of HSN may provide clues for AICA infarction in patients with acute audiovestibular loss.

Sudden vertigo in a 49-year-old man

The diffusion-weighted MRI (DWI) showed a small, subacute right middle cerebellar peduncle infarct in the territory of the anterior inferior cerebellar artery (AICA) without brainstem infarction (Fig. 1). Audiometry showed a total right hearing loss with normal hearing on the left; caloric testing showed absent responses from the right. CT angiography revealed only right vertebral artery hypoplasia. He was given anti-hypertensive treatment and aspirin. One year later he still had a total right hearing loss, positive rightward Head Impulse Test, a positive Romberg test standing on foam and absent caloric responses from the right. Sudden unilateral vestibular loss (SVL) produces a stereotyped syndrome of vertigo, vomiting, nystagmus beating away from the affected side, ipsiversive lateropulsion and ocular tilt reaction. The Head Impulse Test is invariably positive towards the affected side. Whereas the SVL syndrome invariably resolves within 1 week, the Head Impulse Test will, if the ear does not recover, remain positive forever. When the SVL is spontaneous and isolated, the cause is usually presumed to be due to herpes simplex virus infection and since the cochlea is spared, it is called ‘‘acute vestibular neuritis’’. When there is simultaneous sudden unilateral hearing loss (SHL) the cause is presumed to be herpes zoster virus infection – ‘‘herpes zoster oticus’’ or the ‘‘Ramsay Hunt syndrome’’, affecting the labyrinth as well as in the vestibulo-cochlear nerve, and such cases are called ‘‘acute viral labyrinthitis’’ or ‘‘neuro-labyrinthitis’’. However, labyrinthine infarction can also cause combined SVL+SHL, although this diagnosis is as hard to verify as that of viral labyrinthitis, since MRI of the inner ear is usually normal in both. The internal auditory artery, usually a branch of the AICA, supplies the inner ear. With AICA occlusion there can be infarction in the cerebellum or the brainstem, or both, as well as the inner ear. The hearing loss with AICA infarction is mostly cochlear and can improve in time, as can the canal paresis. A cerebellar or even brainstem component of an AICA territory infarct, evident on DWI, can be clinically asymptomatic so that the patient will present with isolated SHL+SVL and if a DWI is not requested (in time), the patient will be assumed to have viral

Vertebrobasilar angulation and its association with sudden sensorineural hearing loss

The pathogenesis of sudden sensorineural hearing loss (SSNHL) is unclear, though some researchers postulate the major mechanism of onset to be via circulatory disturbance or cochlear inflammation. SSNHL can represent the sole manifestation of anterior inferior cerebellar artery infarction, and patients with a SSNHL may have higher than normal risk of future stoke. According to a vascular remodeling theory, vertebral arteries (VAs) are typically asymmetric with the basilar artery (BA) gradually curving in the opposite direction of the larger VA. Decreased wall shear stress on the inner surface of the curvature (weaker side of the vertebral artery) gives rise to an atherothrombogenic environment. It is hypothesized that angulation of the BA could contribute to the decline of anterior inferior cerebellar artery (AICA) flow or to the development of atheroma formation in the AICA orifice. Vertebrobasilar junction angulation could represent a simple and useful marker of SSNHL caused by a vascular compromise of the cochlea.

Isolated Hearing Loss as First Presentation of Anterior Inferior Cerebellar Artery Infarcts: A 3-Year Study (P01.036)

Objective: To study the above syndrome in patients with anterior inferior cerebellar artery infarcts. Background Anterior inferior cerebellar artery (AICA) infarcts may present with hearing loss (without brainstem signs and symptoms) at stroke onset due to labyrinthine artery ischemia. Unilateral hearing loss is often misdiagnosed as peripheral hearing disorder. Bilateral hearing loss may have a vascular etiology, especially in elderly patients with risk factors. Design/Methods: This is a prospective study of all stroke patients presenting with isolated hearing loss (without central signs and symptoms) to the National Neuroscience Institute, Singapore, from 2009 to 2011. History, serial neurological examination and brain scans were noted. Final diagnosis was confirmed by MRI brain. Results: Four patients (mean age 66 +/- 10 years, all males) met study criteria. All had one or more risk factors. Two presented with bilateral hearing loss and two with unilateral hearing loss. Audiogram showed sensorineural hearing loss in all cases. One patient with unilateral hearing loss had concomitant vestibulopathy with nystagmus and positive head thrust. Both patients with unilateral hearing loss had normal initial MRI brain and were misdiagnosed as peripheral disorders. They developed ataxia and dysarthria over one week and repeated MRI showed pontine and cerebellar infarcts. One patient with bilateral hearing loss was initially diagnosed as Meniere9s disease. As he was elderly (68 years old) and had hypertension, MRI brain was done which showed bilateral cerebellar infarcts. The second patient with bilateral hearing loss also had multiple risk factors and MRI brain showed bilateral cerebellar and left occipital infarcts. Brainstem auditory evoked response showed bilateral absent wave I and ill-formed waves III and V. Conclusions: Hearing loss from AICA infarcts may be misdiagnosed as peripheral hearing disorders. Bilateral hearing loss, especially in elderly patients with risk factors, should prompt the clinician to consider a vascular cause. Disclosure: Dr. Sivalingam has nothing to disclose. Dr. Chua has nothing to disclose.

Cortical and cerebellar hypometabolism after bilateral antero-inferior cerebellar artery infarct

A 55-year-old man with a history of hypertension, hypercholesterolemia, and tobacco use presented with sudden onset bilateral deafness, gait ataxia, and dysarthria. Clinical examination disclosed left-sided limb ataxia, bilateral gaze-evoked nystagmus, dysarthria, and bilateral hearing loss. Brain MRI showed a bilateral anterior inferior cerebellar artery (AICA) infarction (figure, A). Fluorodeoxyglucose PET scan ([18F] FDG PET) performed because of mild frontal syndrome (euphoria and decreased spontaneous activity) showed a mild cerebellar and prefrontal cortex hypometabolism (figure, B). He recovered after 1 month without sequelae. Five months later, he complained of apathy, poor motivation, and lack of interest in previous hobbies. Neuropsychological investigations disclosed a mild impairment of processing speed, alphabetic verbal fluency, attention and executive dysfunction such as difficulties in planning and disturbed mental flexibility; semantic and episodic memory and praxis were normal. An [18F] FDG PET control showed a severe bilateral cerebellar, frontal, temporal, and parietal hypometabolism (figure, …