Bilateral sudden deafness as a prodrome of anterior inferior cerebellar artery infarction

Background: Acute ischemic stroke in the distribution of the anterior infer ior cerebellar artery is known to be associated with hearing loss, facial w eakness, ataxia, nystagmus, and hypalgesia. There have been few reports on bilateral deafness and vertebrobasilar occlusive disease. Furthermore, prev ious reports have not emphasized the inner ear as a localization of bilater al deafness. Objective: To describe the presentation of acute ischemic stroke in the dis tribution of the anterior inferior cerebellar artery as sudden bilateral he aring loss with minimal associated signs. Design and Setting: Case report and tertiary care hospital. Patient: A 66-year-old man with diabetes mellitus developed sudden bilatera l deafness, unilateral tinnitus, and vertigo 7 days before the onset of dys arthria, facial weakness, and ataxia. T2-weighted magnetic resonance imagin g scans showed hyperintensities in the right lateral pons and right middle cerebral peduncle and a possible abnormality of the left middle cerebellar peduncle. A magnetic resonance angiogram showed moderately severe stenosis of the distal vertebral artery and middle third of the basilar artery. The patient's right limb coordination and gait improved steadily over several w eeks, but there was no improvement in hearing in his right ear. Conclusions: The relatively isolated onset of deafness as well as the sever ity and persistence of the hearing loss led us to conclude that the hearing loss in this case was likely due to prominent hypoperfusion of the interna l auditory artery, with labyrinthine infarction as the earliest event. Vert ebrobasilar occlusive disease should be considered in the differential diag nosis of sudden bilateral deafness.