Cases of primary isolated audiovestibular loss and subsequent anterior inferior cerebellar artery (AICA) dissection infarction caused by AICA dissection have rarely been reported in previous literature. Moreover, most existing reports on AICA dissection involve dissecting aneurysms associated with subarachnoid hemorrhage. This video shows a healthy 46-year-old man without vascular risk factors presenting with an initial audiovestibular loss as a prodromal ischemia sign and subsequent AICA infarction. A possible etiological assumption for most cases of this presentation is that a branch atheromatous plaque in the parent basilar artery may extend into the orifice of the AICA, resulting in decreased blood flow to the relevant AICA consequently causing ischemia in the inner ear. Given that the AICA is a small intracranial artery, it is helpful to keep in mind that conventional computed tomography angiography or magnetic resonance angiography may be insufficient to identify isolated steno-occlusive lesions due to AICA dissection without aneurysmal changes. Immediate cerebral catheter angiography can be a useful neuroimaging modality for accurate early diagnosis of AICA dissection. This case indicates that spontaneous AICA dissection is a rare cause of isolated audiovestibular loss before broader AICA infarction in young patients without vascular risk factors.
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