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Embolic internal auditory artery infarction from vertebral artery dissection
Kwang-Dong Choi1, Jong-Un Chun, Moon Gu Han
1Department of Neurology, College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
Journal of the Neurological Sciences
|April 4, 2006
Summary
Sudden vertigo and hearing loss in a 51-year-old man were linked to a vertebral artery dissection causing lateral medullary infarction. This suggests artery-to-artery embolism may cause isolated labyrinthine infarction.
Area of Science:
- Neurology
- Vascular Neurology
- Neuro-otology
Background:
- Vertebral artery dissection can lead to ischemic stroke in the posterior circulation.
- Lateral medullary infarction (Wallenberg syndrome) presents with a distinct constellation of neurological deficits.
- Understanding the embolic mechanisms is crucial for preventing recurrent events.
Observation:
- A 51-year-old man presented with acute vertigo, right hearing loss, and dysphagia.
- Neurological examination revealed Horner syndrome, nystagmus, facial palsy, dysarthria, and ataxia.
- Audiometry confirmed sensorineural hearing loss and canal paresis.
Findings:
- Brain MRI and angiography diagnosed right lateral medullary infarction secondary to vertebral artery dissection.
- The infarction affected the lateral medulla without involving territories typically supplied by the anterior inferior cerebellar artery (AICA).
- This pattern points towards an artery-to-artery embolism mechanism.
Implications:
- This case highlights artery-to-artery embolism as a potential cause of isolated labyrinthine infarction.
- It underscores the importance of considering vertebral artery dissection in patients with acute vertigo and hearing loss.
- Early diagnosis and management of vertebral artery dissection are critical to prevent further embolic events and neurological damage.