[Vestibulocochlear infarct: a challenging diagnosis]

Vestibulocochlear infarct, most commonly associated with infarction of a terminal branch of the anterior inferior cerebellar artery, presents with acute vertigo and sensorineural hearing loss. It often mimics peripheral vestibular disorders and may show no abnormal findings on neuroimaging, making the diagnosis particularly challenging. Without appropriate treatment, permanent unilateral hearing loss can significantly impair patients' quality of life. This review synthesizes findings from recent studies regarding the clinical characteristics, diagnostic approach, and therapeutic strategies of this condition. Patients typically present with prolonged vertigo (>24 hours), unilateral hearing loss, tinnitus, and imbalance. On examination, peripheral signs such as a positive head impulse test or horizontal-rotatory nystagmus may be observed, while the only indicator of a central origin is the hearing loss, often subtle or unnoticed even by the patient. Vascular comorbidities, including hypertension and diabetes mellitus, constitute key risk factors. Diagnostic difficulties arise from overlap with idiopathic sudden sensorineural hearing loss and vestibular neuritis; a vascular origin may account for up to 15-20% of acute audio-vestibular syndromes in high-risk populations. Early thrombolysis or antiplatelet therapy may improve outcomes, though thrombolysis is rarely administered due to the lack of imaging evidence. For diagnosis, video head impulse testing, audiometry, and MR neuroimaging are essential. Management relies on vestibular and auditory rehabilitation for persistent vertigo and secondary stroke prevention. Our review highlights the underdiagnosis of vestibulocochlear stroke and advocates for an integrated neuro-otological and vascular diagnostic protocol in patients presenting with vertigo and hearing loss to facilitate faster and more effective treatment. Orv Hetil. 2026; 167(33): 1309-1317.