Missed Anterior Inferior Cerebellar Artery Aneurysm Mimicking Vestibular Neuritis—Clues to Prevent Misdiagnosis

Abstract

We discuss a case with combined vestibulocochlear and facial neuropathy mimicking a less urgent peripheral vestibular pattern of acute vestibular syndrome (AVS). With initial magnetic resonance imaging read as normal, the patient was treated for vestibular neuropathy until headaches worsened and a diagnosis of subarachnoid hemorrhage was made. On conventional angiography, a ruptured distal right-sided aneurysm of the anterior inferior cerebellar artery was diagnosed and coiled. Whereas acute vestibular loss usually points to a benign peripheral cause of AVS, combined neuropathy of the vestibulocochlear and the facial nerve requires immediate neuroimaging focusing on the cerebellopontine angle. Imaging should be assessed jointly by neuroradiologists and the clinicians in charge to take the clinical context into account. AbstractWe discuss a case with combined vestibulo-cochlear and facial neuropathy mimicking a less

Dissecting aneurysm of the anterior inferior cerebellar artery in the internal auditory canal presenting with deafness without hemorrhage: A case report and literature review

“…[3] Five (19.2%) patients, including our patient, sought medical attention due to acute or slowly progressing eighth nerve symptom without SAH [Table 1]. [5,9,20,38] Two of them had AVM, [9,38] one had mycotic aneurysm, [5] and our patient had dissecting aneurysm; the causative factor was not described in one patient. [20] e preoperative diagnosis was schwannoma in two patients.…”

“…[10] To the best of our knowledge, intrameatal AICA aneurysm has been reported in only 26 patients (21 women), including our patient. [3,5,6,8,9,11,13,14,15,[17][18][19][20]22,25,29,32,33,35,37,38,40,41] e patients' ages ranged from 35 to 83 years, with a mean age of 61.3 ± 14.0 (standard deviation) and median age of 62 years. e comorbidities included hypertension in seven patients, dyslipidemia in four patients, and diabetes mellitus in three patients.…”

“…ree patients also had arteriovenous malformation (AVM) distal to the AICA aneurysm. [9,19,38] Dissection involving the AICA was observed in three patients. [8,11] Twenty-one (80.8%) patients were admitted due to SAH as the initial presentation.…”

“…[4,10,26,29] However, an aneurysm in the internal auditory canal (IAC) is rare; only 25 cases have been reported thus far. [3,5,6,8,9,11,13,14,15,[17][18][19][20]22,25,29,32,33,35,37,38,40,41] It generally presents with subarachnoid hemorrhage (SAH). Herein, we have reported an extremely rare case of intrameatal aneurysm caused by dissection of the AICA, presenting initially with the eighth nerve palsy and then the seventh nerve palsy without SAH.…”

Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms

“…3,8 Rarely, distal anterior inferior cerebellar artery aneurysms that project into the internal acoustic meatus can cause facial weakness or hearing loss from compression of the facial (CN VII) and vestibulocochlear (CN VIII) nerves. 10,17 Cranial nerve syndromes can be useful bedside clues to the diagnosis of an intracranial aneurysm and also guide subsequent evaluation. For example, an acute CN III palsy is presumed to be a PCoA aneurysm until proven otherwise, and indicates urgent angiography and treatment.…”