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Course: Spontaneous AICA Dissection Presenting With Isolated Audiovestibular Loss

CME Credits: 1.00

Released: 2023-10-02

A 46-year-old man visited the emergency department (ED) with a chief complaint of vertigo lasting for a few minutes and sudden right-sided hearing loss. He was a current smoker but had no history of headache or current medication. He reported no recent head trauma and had not performed vigorous exercise at or before symptom presentation. On arrival at the ED, the patient had no vertigo or imbalance; however, his right-sided hearing loss persisted. Initial diffusion-weighted imaging and brain magnetic resonance imaging (MRI) in the ED revealed no intracranial pathology. Pure tone audiography indicated a moderate degree of right-sided sensorineural hearing loss. He was diagnosed with acute labyrinthitis and was admitted to the otolaryngology department, where he underwent combination therapy with dexamethasone and antiviral agents. The following morning, he reported waking up with new-onset right facial palsy, dysarthria, and numbness in the left arm and leg. The second diffusion-weighted imaging revealed acute ischemic stroke in the right cerebellar hemisphere, middle cerebellar peduncle, and dorsomedial pons (, A). No apparent steno-occlusive lesion in the parent vertebrobasilar arteries was observed with time-of-flight magnetic resonance angiography.


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