Dynamic changes in the inner ear function and vestibular neural pathway related to the progression of labyrinthine infarction in patient with an anterior inferior cerebellar artery infarction

Duk Rim Kim, Hyo-Jeong Lee, Hyung-Jong Kim, Sung Kwang Hong
Otology & Neurotology 2011, 32 (9): 1596-9

OBJECTIVE: To describe changes in the inner ear function and the vestibular neural pathway according to the progression of a labyrinthine infarction in a patient with an anterior inferior cerebellar artery (AICA) infarction.

PATIENT: A 58-year-old woman with hypertension who presented with isolated inner ear symptoms similar to those of endolymphatic hydrops but finally progressed to an AICA infarction.

INTERVENTION: Serial neurotologic testing according to progression to an AICA infarction and antiplatelet therapy.

MAIN OUTCOME MEASURES: Radiologic findings and neurotologic parameters, including pure tone audiogram thresholds, spontaneous nystagmus, summating potentials/action potentials on electrocochleography, interaural amplitude difference on the vestibular-evoked myogenic potential test, canal paresis and fixation index on the bithermal caloric test, and gain on oculomotor tests.

RESULTS: Our patient initially presented with sudden hearing loss and was diagnosed with an acute AICA infarction on a follow up MRI. Dynamic change in neurotologic testing was observed during disease progression. The vertigo and motion intolerance improved gradually after antiplatelet therapy.

CONCLUSION: Changes in the clinical profile, which were documented during a transition from isolated labyrinthine ischemia to an AICA infarction, suggest that sensitivity to an ischemic injury is variable in different components of the labyrinthine organs in addition to providing a new insight into the response of vestibular neural pathway to ischemic injury.

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