From Dizziness and Hearing Loss to Coma: A Case of Basilar Artery Occlusion

Basilar artery (BA) occlusion is a rare and devastating cause of ischemic stroke. Presenting symptoms are frequently non-specific and include dizziness, vertigo, nausea, vomiting, headache, and, rarely, hypoacusis. Clinical history and appropriate neurological evaluation are essential for diagnosis. We present the case of a 65-year-old female with dizziness, vomiting, dysarthria, and hearing loss, progressing to right-side hemiparesis and decreased level of consciousness culminating in a coma in just a few hours. She had an atherothrombotic BA occlusion and was submitted to mechanical thrombectomy with full artery recanalization, resulting in rapid neurological improvement in the first days after treatment and almost full recovery during the following months. Early suspicion of posterior circulation stroke from non-specific symptoms is paramount for correct diagnosis and timely treatment, which has an important impact on disability and mortality. Early and complete BA recanalization can result in a positive outcome in a disease that would otherwise be extremely severe. All physicians should be aware of a possible posterior circulation stroke in patients presenting with dizziness, vertigo, vomiting, or sudden hypoacusis and should meticulously search for specific signs or symptoms of neurological dysfunction such as nystagmus, gaze palsies, dysarthria, hemiparesis, or a decreased level of consciousness.