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Sudden deafness without associated neurological signs and symptoms is typically attributed to a viral inflammation of the labyrinth. Sudden deafness as a heralding manifestation of basilar occlusion has rarely been described. A 60-year-old male with hypertension presented with an acute onset of isolated sudden deafness with vertigo. On admission, initial brain MRI, including diffusion-weighted images, was normal. Two days after the onset of symptoms, the patient presented with an exacerbation of vertigo. A follow-up MRI scan revealed new infarcts involving the right middle cerebellar peduncle, right dorsolateral pons and right anterior cerebellum. In this patient, the acute onset of isolated sudden deafness with vertigo may have been a heralding manifestation of the pontocerebellar infarction. [ABSTRACT FROM AUTHOR]