Inner-Ear Symptom May Herald Basilar Artery Occlusion

A 75-year-old Japanese man suddenly experienced right cochlear and vestibular dysfunction. Basilar artery occlusion and silent right cerebellar infarction were identified 3 days later. These were treated with intravenous ozagrel (an antiplatelet agent) and edaravone, a free-radical scavenger. The patient did not develop cerebello-brainstem signs. His first sign most probably reflected a right labyrinthine artery occlusion that heralded, or occurred together with, the basilar artery occlusion. This case highlights the possibility that a sudden inner ear dysfunction may herald a basilar stroke. Clinicians should therefore initiate appropriate therapy to prevent life-threatening brainstem complications.