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We report a case of severe headache associated with cerebellar infarction was successfully treated with Kampo therapy. The patient complained of severe headache and vertigo in spite of standard therapy after the decompression craniectomy. However, his symptoms were relieved immediately by administration of goreisan. The pharmacological effect of Kampo formulation i.e. goreisan is still unknown, but this formulation has been used for headache with edema, vertigo and vomiting. According to the classic textbook, this formulation has a potential to improve water imbalance in the body, including brain edema. This Kampo medicine is seemed to be an alternative to manage such patients.
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Objective:To explore the relations of changes in the cognitive function with brain structure network in patients with cerebellar infarction.Methods:Thirty-six patients with cerebellar infarction at the posterior lobe, admitted to our hospital from July 2016 to October 2019, were chosen as cerebellar infarction group; and 30 healthy subjects matched with age, gender, and education level at the same time period were used as control group. Neurocognitive and behavioral tests were performed on both groups to assess the cognitive functions, and MR imaging was performed to obtain diffusion tensor imaging (DTI) data. Deterministic tractography and graph theory were used to obtain the structural brain network and network parameters of all subjects. The differences of clinical data and brain network topological characteristic parameters between the two groups were compared, and the correlation between the subjects' brain structural network characteristic parameters and cognitive function was analyzed.Results:As compared with the control group, patients in the cerebellar infarction group had significantly lower Mini-mental State Examination (MMSE), Montreal Cognitive Scale (MoCA), Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test (DST), Clock Drawing Test (CDT) and Berg Balance Scale (BBS) scores, and significantly longer Trail Making Test (TMT) time-consuming ( P<0.05). As compared with the control group, the cerebellar infarction group showed significantly decreased global efficiency (Eglob) and local efficiency (Eloc) in the brain network, and significantly increased clustering coefficient (Cp) and length of path (Lp, P<0.05). As compared with the control group, the cerebellar infarction group had significantly reduced nodal efficiency in 14 brain regions ( P<0.05), including bilateral median cingulate and paracingulate gyri (DCG), left inferior frontal gyrus-opercular part (IFGoperc), bilateral supplementary motor area (SMA), bilateral precuneus (PCUN), left inferior frontal gyrus-orbital part (ORBinf), left temporal pole-superior temporal gyrus (TPOsup), left temporal pole-middle temporal gyrus(TPOmid), left inferior parietal-supramarginal and angular gyri (IPL), bilateral posterior cingulate gyrus (PCG), left inferior frontal gyrus-triangular part (IFGtriang). MoCA scores were significantly negatively correlated with Lp ( r=-0.388, P=0.019), and were significantly positively correlated with Eglob ( r=0.350, P=0.036), and efficiencies in the right DCG ( r=0.428, P=0.009), left DCG ( r=0.359, P=0.031) and right PCG ( r=0.350, P=0.037) in the cerebellar infarction patients. The RAVLT scores showed a significantly positive correlation with Eglob ( r=0.338, P=0.044). The TMT-A time-consuming and left DCG had significant negative correlation ( r=0.357, P=0.032). TMT-B time-consuming was significantly negatively correlated with right DCG ( r=-0.432, P=0.008), right PCUN ( r=-0.350, P=0.036) and left DCG ( r=-0.398, P=0.016), and positively correlated with Lp ( r=0.406, P=0.014). Conclusions:There is cognitive dysfunction in multiple domains after acute cerebellar infarction, including memory, executive function, visuospatial ability and attention. At the same time, there are reduced efficiency of information transmission in bilateral PCUN, PCG and DCG, and the frontal temporal lobe; among them, the abnormal changes of the right PCG, bilateral DCG, and right PCUN may play key roles in cognitive dysfunction.
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Objective:To investigate the abnormal changes of fractional amplitude of low frequency fluctuation (fALFF) values in resting-state magnetic resonance imaging and their correlation with cognitive function in patients with different side (left/right) cerebellar infarction.Methods:A total of 22 patients with acute left cerebellar infarction at the posterior lobe (left cerebellar infarction group) and 20 patients with acute right cerebellar infarction at the posterior lobe (right cerebellar infarction group), admitted to our hospital from July 2018 to December 2019, were enrolled; and 22 gender-, age and education level-matched healthy subjects (healthy control group) were chosen at the same time period. Head resting-state functional magnetic resonance imaging and neuropsychological cognitive scale were performed; the correlations between characteristics of fALFF changes and cognitive function changes of these patients were investigated.Results:(1) As compared with the healthy control group, patients in the left cerebellar infarction group and right cerebellar infarction group had significantly lower scores of Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Rey auditory verbal learning test (RAVLT), and significantly longer Trail Making Test (TMT) time-consuming ( P<0.05); the TMT time-consuming in right cerebellar infarction group was significantly longer than that in left cerebellar infarction group ( P<0.05). (2) There were significant differences in fALFF values among the 3 groups in the right cingulate gyrus, right inferior frontal gyrus, and left superior frontal gyrus ( P<0.05, Alphasim-revised). As compared with the healthy control group, the fALFF values in the right middle frontal gyrus, right inferior frontal gyrus and right cingulate gyrus of left cerebellar infarction group were significantly increased, and fALFF values in the right hippocampus of right cerebellar infarction group were significantly increased ( P<0.05, Alphasim-revised). (3) In patients from left cerebellar infarction group, MoCA scores were negatively correlated with the fALFF values in the right frontal lobe, right inferior parietal lobule and right cingulate gyrus ( P<0.05); RAVLT scores were negatively correlated with fALFF values in right inferior parietal lobule and positively correlated with fALFF values in occipital lobe ( P<0.05); correlation analysis between fALFF values and TMT scores demonstrated a positive correlation in the right parietal lobe and right cingulate gyrus ( P<0.05). In patients from right cerebellar infarction group, MoCA scores were positively correlated with the fALFF values in the right frontal lobe ( P<0.05); MoCA scores were negatively correlated with the fALFF values in the right inferior parietal lobule ( P<0.05); RAVLT scores were positively correlated with fALFF values in the left cingulate gyrus, and TMT time-consuming was negatively correlated with fALFF values in left parietal lobe ( P<0.05). Conclusions:Patients with cerebellar infarction have cognitive dysfunction. Unilateral cerebellar infarction can cause compensatory increase of fALFF values in key brain regions of the contralateral cerebral hemisphere. Abnormal fALFF changes are closely related to the degrees of cognitive dysfunction.
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Acute hydrocephalus is a rare manifestation of posterior circulation strokes. Clinical worsening and coma may occur in addition to these symptoms of cerebellar dysfunction. Timely and careful approach will certainly prove to be life saving when deciding for a shunt procedure in a patient developing obstructive hydrocephalus following cerebellar infarct. The case presented here is a reminder for both this rare complication, and the treatment approach. We present a patient with cerebellar infarct and secondary obstructive hydrocephalus. Forty three year old male patient was brought to the emergency room in our hospital with unconsciousness, before that patient with suddenly developing dizziness, loss of balance and vomiting. His neurological examination showed that he was coma. The patient's brain computed tomography scan showed severe third and lateral ventricular dilation suggestive of obstructive hydrocephalus. Following shunt placement and suboccipital decompression, the patient recovered and was able to walk without assistance. Cerebellar infarcts may cause death as a result of pressure increase in the posterior fossa and pressure on the brain stem due to edema. Moreover, the aquaductus or the fourth ventricle may close because of edema and cause obstructive hydrocephalus and acute intracranial pressure increase. Temporary external ventricular drainage or permanent shunt systems and surgical decompression of the posterior fossa may be considered to prevent progressive neurologic worsening. In conclusion, we wished to point out that a timely surgical procedure in a cerebellar infarct case where acute hydrocephalus developed could be life saving.
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Objective To investigate the complications of different enteral nutrition in patients after surgery for massive cerebellar infarction,so as to guide rational application of enteral nutrition in patients.Methods Forty-nine patients with massive cerebellar infarction were divided into three groups randomly:conventional nasogastric tube feeding group (group A,n =12),nasogastric tube feeding plus gastric motor drug group (group B,n =18),and nasojejunal tube feeding group (group C,n =19).The incidences of diarrhea,reflux,aspiration,upper gastrointestinal bleeding and aspiration pneumonia within 3 weeks after initiation of enteral nutrition were observed and compared among the groups.Results The incidence of diarrhea showed no statistically significant difference among the 3 groups (x2 =0.092,P =0.955).Compared with group A,the incidences of reflux,aspiration and aspirafion pneumonia were significantly lower in group B and group C (P ＜ 0.05),and lower in group C compared with group B (P ＜ 0.05).Compared with group C,the incidence of upper gastrointestinal bleeding was significantly lower in group C than in group A and group B (x22 =4.748,P2 =0.029;x23 =4.284,P3 =0.038),but the difference between group A and group B was not significant (x21 =0.000,P1 =1.000).Conclusions Because of the unique pathophysiological features in patients after surgery for massive cerebellar infarction,early enteral nutrition by conventional nasogastric tube feeding may be inappropriate.Nasogastric tube feeding plus gastric motor drug may be applied in mild case with short course of disease.Nasojejunal tube feeding may be the approach of choice for enteral nutrition in critical patients with massive cerebellar infarction for its association with lower incidence of complications.
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Objective To investigate the effects of therapeutic equipment that aimed to improve cerebrovascular func?tion combined with electric standing bed on balance disorder following cerebellar infarction. Methods Fifty patients with balance disorder after cerebellar infarction were randomized into study and control groups. Agreed routine rehabilitation ther?apy including automatic standing bed and medication were given to both groups. In addition, therapeutic equipment that aim to improve cerebrovascular function were delivered to patients in study group. The effects were assessed using Fugl-Meyer balance function scale and Barthel index (BI) before and after 4 weeks of treatment. Results Study group and control group did not present difference between FM-B grade and BI before treatment (P>0.05). Both FM-B and BI were improved after treatment (P<0.05), but it improved more in study group than in control group (P<0.05). The total efficiency in treatment group is higher than that in control group (P<0.05). In the process of treatment, no obvious adverse reactions was observed. Conclusion The therapeutic equitment that aim to improve cerebrovascular function combined with automatic standing bed can improve balance disorder and daily activity after cerebellar infarction.
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As a rare cerebrovascular disease, cerebral venous thrombosis (CVT) is caused by various conditions including trauma, infection, oral contraceptive, cancer and hematologic disorders. However, iron deficiency anemia is not a common cause for CVT in adult. Posterior fossa infarction following CVT is not well demonstrated because posterior fossa has abundant collateral vessels. Here, we report a case of a 55-year-old man who was admitted with complaints of headache, nausea, and mild dizziness. The patient was diagnosed with isolated lateral sinus thrombosis presenting as cerebellar infarction. Laboratory findings revealed normocytic normochromic anemia due to iron deficiency, and the patient's symptoms were improved after iron supplementation.
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Adult , Humans , Middle Aged , Anemia , Anemia, Iron-Deficiency , Dizziness , Headache , Infarction , Iron , Lateral Sinus Thrombosis , Nausea , Thrombosis , Transverse Sinuses , Venous Thrombosisالملخص
Injury to the vertebral artery during anterior cervical discectomy is rare but potentially fatal. We report a case of cerebellar infarction after endovascular embolization for iatrogenic vertebral artery injury at C5-C6 during an anterior cervical discectomy and fusion. A 61-year-old man had an intraoperative injury of the right vertebral artery that occurred during anterior cervical discectomy and fusion at C5-C6. Hemorrhage was not controlled successfully by packing with surgical hemostatic agents. While the patient was still intubated, an emergency angiogram was performed. The patient underwent endovascular occlusion of the right V2 segment with coils. After the procedure, his course was uneventful and he did not show any neurologic deficits. Brain computed tomographic scans taken 3 days after the operation revealed a right cerebellar infarction. Anti-coagulation medication was administered, and at 3-month follow-up examination, he had no neurologic sequelae in spite of the cerebellar infarction.
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Humans , Middle Aged , Brain , Diskectomy , Emergencies , Follow-Up Studies , Hemorrhage , Infarction , Neurologic Manifestations , Vertebral Arteryالملخص
Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly. The vascular anomaly usually occurs congenitally, and enlarges progressively with aging. Although PAVM has many pulmonary manifestations, its most common symptom is known to be dyspnea on exertion. Non pulmonary complications, such as ischemic stroke, have rarely been reported. In this paper, we report a case of a patient with both cerebellar infarction and an isolated PAVM. The PAVM was diagnosed with transesophageal echocardiography, transcranial Doppler and pulmonary angiography, and treated with embolization.
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Humans , Aging , Angiography , Arteriovenous Malformations , Dyspnea , Echocardiography, Transesophageal , Infarction , Strokeالملخص
El diagnóstico de infarto cerebeloso en su presentación inicial puede ser difícil, su reconocimiento tardío puede asociarse a graves complicaciones. Aunque sólo representa 2 por ciento a 3 por ciento de los infartos encefálicos, afecta a un importante número de pacientes, muchos de los cuales son jóvenes. De todos los infartos de cerebelo sólo 10 por ciento evolucionará en forma maligna, siendo denominado infarto pseudotumoral de cerebelo. Las causas más habituales son la embolia, la disección de la arteria vertebral y la aterotrombosis. La arteria cerebelosa póstero-inferior es la más frecuentemente comprometida, y en un tercio de los casos se encuentra una fuente cardioembólica. Su rasgo distintivo es el efecto de masa, el mismo que ocasiona compresión de troncoencéfalo e hidrocefalia aguda, generando un deterioro cuantitativo de conciencia. Las neuroimágenes, tomografía computada y resonancia magnética de encéfalo, son de vital importancia para establecer la presencia de un infarto cerebeloso e identificar potenciales complicaciones. Es importante recordar que la tomografía computada es menos sensible que la resonancia magnética para establecer el diagnóstico. El manejo especializado multidisciplinario y la implementación de las medidas de soporte generales y específicas pueden mejorar las posibilidades de sobrevida y recuperación funcional. Ante la presencia de un deterioro de conciencia, un abordaje quirúrgico agresivo pareciera ser la mejor opción de tratamiento.
The diagnosis of cerebellar infarction at initial presentation can be difficult, delayed recognition can be associated with serious complications. Although representing only 2 percent to 3 percent of brain infarcts, affects a significant number of patients, many of whom are young. Only 10 percent of cerebellar infarcts evolve into malignant form, being named pseudotumoral cerebellar infarction. Common causes include embolism, vertebral artery dissection and atherothrombosis. The postero-inferior cerebellar artery is the most frequently committed, and one third of cases there is a cardioemboIic sourse. Its distinguishing feature is the mass effect, causing brain stem compression and acute hydrocephalus, and generating a quantitative impairment of consciousness. The brain imaging, computed tomography and magnetic resonance imaging of brain, are of vital importance to establish the presence of a cerebellar infarct and identify potential complications. It is important to remember that computed tomography is less sensitive than magnetic resonance for diagnosis. The multidisciplinary specialized management and implementation of measures of general and specific support can improve the chances of survival and functional recovery. In the presence of impaired consciousness, an aggressive surgical approach appears to be the best treatment option.
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Humans , Cerebellar Diseases/diagnosis , Cerebellar Diseases/therapy , Cerebral Infarction/diagnosis , Cerebral Infarction/therapy , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/therapy , Cerebellar Diseases/etiology , Cerebellar Diseases/physiopathology , Cerebral Infarction/etiology , Cerebral Infarction/physiopathology , Cerebellar Neoplasms/etiology , Cerebellar Neoplasms/physiopathology , Prognosisالملخص
Classically, only lesions in the cerebral cortex have been thought to cause the epilepsy. Although the cerebellar infarction is presented with ataxia, dysmetria and dizziness, we experienced a patient of cerebellar infarction developed immediately after or simultaneously with a clinical seizure. A brain magnetic resonance imaging (MRI) showed acute cerebellar infarction on the bilateral cerebellar hemisphere.
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Humans , Ataxia , Brain , Cerebellar Ataxia , Cerebral Cortex , Dizziness , Epilepsy , Infarction , Magnetic Resonance Imaging , Seizuresالملخص
Objective To observe the clinical curative effect of edaravone on treatment of acute lagre area cerebellar irdarction(ALACI). Methods 31 ALACI patients attacked within 72h were randomly assigned to therapygroup( n = 16) and control group( n = 15). Therapy group took the basic treatment as well as edaravone infused at a dose of 30mg,twice a day for 14 days. Control group took similar treatment to therapy group expect for edaravone.At 0th ,7th, 14th ,21th day after treatment, the C.SS and ability of daily living(ADL) were used to evaluate the recovery of neurological functions. Results Significant difference of CSS and ADL grading were detected between therapygoup and control group at 7th, 14th day( P < 0.05 ), with lower grading in therapy group ; there were significant differ-ence of CSS and ADL grading between therapy goup and control group at 21th day( P < 0.01 ), with lower grading in therapy group. No evident side effect was detected in edaravone therapy group. Conclusion Edaravone is a safe a-gent. It can effectively improve the neurological deficits and daily living ability of ALACI patients.
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Anterior inferior cerebellar artery infarction is the second most common cause of brainstem stroke, and usually accompanied by vertigo, unilateral deafness, ipsilateral facial weakness and ataxia. These symptoms can be confused with other peripheral causes of sudden hearing loss accompanying dizziness including acute labyrinthitis, idiopathic sudden hearing loss, perilymphatic fistula and acoustic neuroma. This case report presents a man who first visited our clinic for sudden hearing loss with vertigo, and whom we treated for acute labyrinthitis. However, 3 days later, left facial numbness was observed and the magnetic resonance imaging (MRI) showed an anterior inferior cerebellar infarction. The patient was then transferred to the neurology department and treated with anticoagulant and antiplatelet agents. After 7 days of treatment, the hearing loss and dizziness were improved and the facial numbness resolved.
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Humans , Arteries , Ataxia , Brain Stem Infarctions , Deafness , Dizziness , Ear, Inner , Fistula , Hearing Loss , Hearing Loss, Sudden , Hypesthesia , Infarction , Labyrinthitis , Magnetic Resonance Imaging , Neurology , Neuroma, Acoustic , Platelet Aggregation Inhibitors , Vertigoالملخص
Objective To observe the efficacy of Shuilongjian in treating cerebellar infarction, and compare with the pure western medicine. Methods 67 inpatients with cerebellar infarction enrolled were divided into two groups according to the method of random digits table, 36 cases in the treatment group and 31 cases in the control group. The control group was given 500 mL dextran by venoclysis, once a day. The treatment group was given Shuilongjian as an additional drug. The therapeutic effect was evaluated according to the nerve function and the total capability in dealing with daily activities. Result All the 67 cases of cerebellar infarction were included in the analysis. The effective rate of the treatment group was better than that of control group with 83.3% and 58.1% (P
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OBJECTIVE: The aim of this study is to determine which patients with progressively deteriorating acute cerebellar infarction would benefit from surgical treatment and which surgical procedure would best benefit them. METHODS: Seventy six patients were treated at our hospital for cerebellar infarction over the past 3 years. Sixty nine patients received conservative management in the neurological department of our hospital. Among them, 7 patients (5 males and 2 females; average age, 49 yrs) were referred to neurosurgical department because of mental deterioration and underwent emergency surgery. Five patients underwent external ventricular drainage with suboccipital craniectomy and two patients underwent suboccipital craniectomy alone. RESULTS: Of the 7 surgically treated patients, 4 patients experienced good recovery and 2 patients experienced moderate disability (disabled but independent) and 1 patient experienced severe disability (conscious but disabled). There was no death. CONCLUSION: In patients conservatively treated for cerebellar infarction and showing mental deterioration and radiologically evident brainstem compression and ventricular enlargement, we strongly recommend suboccipital craniectomy (plus optional external ventricular drainage in case of showing hydrocephalus) as a first treatment option.
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Female , Humans , Male , Brain Stem , Drainage , Emergencies , Infarctionالملخص
A 64-year-old man presented with sudden onset of right-sided hemiparesis, headache, gait disturbance, and recurrent vomiting. A physical examination revealed right-sided hemiparesis, right Horner syndrome, ataxia of the right limbs, and diminished sensation on the left side of his body. Diffusion-weighted MRI revealed an acute right lateral medullary infarction extending from the rostral medulla to the upper cervical cord, and an acute cerebellar infarction in the territory of the medial branch of the posterior inferior cerebellar artery. Magnetic resonance angiography revealed suspicious severe stenosis or near occlusion of the proximal and distal parts of the right vertebral artery, and hypoplasia of the left vertebral artery. We diagnosed ipsilateral hemiparesis with lateral medullary infarction (Opalski's syndrome) and concomitant cerebellar infarction.
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Humans , Middle Aged , Arteries , Ataxia , Constriction, Pathologic , Extremities , Gait , Headache , Horner Syndrome , Infarction , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Paresis , Physical Examination , Sensation , Vertebral Artery , Vomitingالملخص
Acute ischemic stroke in the distribution of anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness and gait ataxia. A few reports have carefully examined the deafness associated with the AICA infarction. A 55 year old man was presented with right sudden hearing loss, tinnitus and vertigo. The magnetic resonance image of the brain with 4-vessel angiogram showed stenosis in the lower third of the basilar artery due to partial thrombosis and no remarkable lesion in AICA. Although heparin treatment was done, the patient's hearing was not improved. After 3 months of heparin treatment, the patient was presented again with left sudden hearing loss, tinnitus and facial palsy. The magnetic resonance image and angiogram showed increased size of thrombosis and non-visualization of left vertebral artery and basilar artery. Diffusion scan showed focal infarction involving the left AICA territory. Recently, we experienced a case of bilateral sudden hearing loss caused by the right AICA plus syndrome and the left AICA infarction. So authors report this case with a review of literature.
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Humans , Middle Aged , Arteries , Basilar Artery , Brain , Constriction, Pathologic , Deafness , Diffusion , Facial Paralysis , Gait Ataxia , Hearing , Hearing Loss, Sudden , Heparin , Infarction , Stroke , Thrombosis , Tinnitus , Vertebral Artery , Vertebrobasilar Insufficiency , Vertigoالملخص
Hyperhomocysteinemia is an independent risk factor for cerebrovascular disease. Hyperhomocysteinemia can be caused by the defect of the remethylation pathway including the 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene or the transsulfuration pathway including the cystathionine beta-synthase (CBS) gene of homocysteine metabolism. The major cause of severe hyperhomocysteinemia is CBS gene mutation. A 16-year-old male was admitted with vertigo. Brain MRI showed right cerebellar infarction. The plasma homocysteine level was 175 mocro mol/L. According to a genetic evaluation, the patient had the MTHFR 677TT and CBS 1080TT genotypes.
الموضوعات
Adolescent , Humans , Male , Brain , Cystathionine beta-Synthase , Genotype , Homocysteine , Hyperhomocysteinemia , Infarction , Magnetic Resonance Imaging , Metabolism , Oxidoreductases , Plasma , Risk Factors , Stroke , Vertigoالملخص
BACKGROUND: Many studies about unilateral cerebellar infarctions (UCI) have been reported to delineate the clinical findings and stroke mechanisms but have not been studied extensively in acute bilateral cerebellar infarctions (BCI). In order to evaluate the neurological features and mechanisms of BCI, we compared those between BCI and UCI. METHODS: Using diffusion-weighted imaging, we divided 103 patients with acute cerebellar infarctions into two groups: BCI and UCI. Clinical features, outcome and their mechanisms were compared between the groups. RESULTS: Among the 103 patients, 45 patients (44%) had BCI and the remaining 58 patients had UCI. The PICA territory was the most frequently involved site in both groups, and 15 patients were non-territorial infarctions. Clinical symptoms and signs were not different between the groups, however, most patients with decreased mentality had BCI (86%) and also had concomitant lesions outside the cerebellum (72%). Patients with BCI showed poorer prognosis than UCI (modified Rankin score, 1.41 and 2.87 respectively). Other factors included the presence of concomitant lesiona outside the cerebellum, however, mass effect did not affect their prognosis. The main cause of BCI was large artery disease (57%), whereas about half of the patients with UCI (51%) had no demonstrable cause of stroke. CONCLUSIONS: Owing to its poorer outcome and its higher frequency of demonstrable causes of stroke, more intensive work-up, such as vascular study, may be warranted in the patients with acute BCI.
الموضوعات
Humans , Arteries , Cerebellum , Infarction , Magnetic Resonance Imaging , Pica , Prognosis , Strokeالملخص
BACKGROUND AND OBJECTIVES : Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness, and gait ataxia. There have been few reports on deafness associated with the AICA infarction. Furthermore, previous neurological reports have not emphasized the inner ear as a localization of sudden deafness. The aim of this study was to investigate the incidence of deafness associated with the AICA infarction and the sites predominantly involved in deafness. MATERIALS AND METHOD : During two years we prospectively identified 12 consecutive patients with unilateral AICA infarction diagnosed by brain MRI. Pure tone audiogram, speech discrimination testing, stapedial reflex testing, and auditory brainstem responses were performed to localize the site of lesion in the auditory pathways. Electronystagmography was also performed to evaluate the function of the vestibular system. RESULTS :The most common affected site on brain MRI was the middle cerebellar peduncle (11). Four patients had vertigo and/or acute auditory symptoms such as hearing loss or tinnitus as an isolated manifestation from 1day to 2 months prior to infarction. Audiological testings confirmed sensorineural hearing loss in 11 (92%) patients, predominantly involved the cochlea in 6 and retrocochlear in 1. The other 4 patients had a severe to profound hearing loss most likely of cochlear origin. Electronystagmography demonstrated no response to caloric stimulation in 10 (83%) patients. CONCLUSIONS : In our series, sudden deafness was an important sign for the diagnosis of the AICA infarction. Audiological examinations suggest that sudden deafness in AICA infarction is usually due to dysfunction of the cochlea, resulting from ischemia to the inner ear.