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Abstract: A 74-year-old woman with sudden vertigo and dysarthria showed spontaneous nystagmus beating rightward, upward and clockwise. She also exhibited dysfunction of the left utricle and superior and horizontal canals, which was documented by head impulse and heave tests, measurements of ocular torsion and subjective visual vertical tilt, bithermal caloric tests, and rotation axis analysis of the spontaneous nystagmus. In contrast, functions of the left posterior canal, saccule, and cochlea were remained intact, as evidenced by normal head impulse test, audiometry and vestibular evoked myogenic potential. MRI revealed an acute infarction in the left lateral pons of anterior inferior cerebellar artery (AICA) territory. Our patient with AICA infarction showed isolated damage to the superior vestibular labyrinth or its afferents with preservation of the inferior vestibular labyrinth and auditory function. Our patient provides further evidence that isolated damage to the superior vestibular labyrinth or its afferents may be a mechanism of isolated vascular vertigo. [Copyright &y& Elsevier]

Abstract: Antemortem diagnosis of isolated inner ear infarction remains a diagnostic challenge since current imaging techniques do not permit differentiation of isolated labyrinthine infarction from other more benign disorders involving the inner ear. An 81-year-old woman with diabetes, hypertension and hypercholesterolemia presented with vertigo and hearing loss. Initial examination revealed findings of left cochleovestibular labyrinthitis without brainstem or cerebellar signs. MRIs including the diffusion-weighted images were normal. Five days later, however, she developed dysarthria, and decreased facial sensation, subtle facial palsy, and dysmetria in the left side. Follow-up MRI was consistent with acute infarctions in the territory of anterior inferior cerebellar artery (AICA), involving the left lateral pons, left middle cerebellar peduncle, and inferolateral cerebellum. AICA infarction should be considered in acute audiovestibular syndrome, especially in aged patients with vascular risk factors, even though the classic brainstem or cerebellar signs are absent. [Copyright &y& Elsevier]