![aica and pica syndrome aica and pica syndrome](https://image1.slideserve.com/2976982/slide27-l.jpg)
#AICA AND PICA SYNDROME SERIES#
Unfortunately, the frequency of audiovestibular loss associated with stroke among a consecutive series of the patients with audiovestibular loss of various causes has not yet been identified in the literature. Īs mentioned above, many neurological or neurotological diseases including AICA territory ischemic stroke can cause audiovestibular loss.
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Indeed, the cochlear nuclei receive a rich blood supply from multiple sources, including branches of the AICA and PICA. Isolated vestibular nucleus infarction has been recently identified as a cause of isolated vertigo, but isolated audiovestibular loss due to a focal infarction restricted to the vestibular and cochlear nuclei in the brainstem has not yet been identified in the literature. A patient with isolated audiovestibular loss showed a small infarction restricted to the root entry zone of the eighth nerve in the brainstem, suggesting that the root entry zone of the eighth nerve can be considered as a candidate site responsible for isolated audiovestibular loss. By contrast, the eighth nerve in the auditory canal, the cerebellopontine angle, and the root entry zone is known to have a rich network of anastomosing vessels from the dural mater, petrous bone, AICA, PICA, and vertebral arteries. Because the inner ear requires a high-energy metabolism and the IAA is an end artery with little collateral from the otic capsule, the inner ear is particularly vulnerable to ischemia. In audiovestibular loss due to stroke, however, the lesions are mostly found in the inner ear, which is always supplied by the IAA. In theory, injury to any structures conveying the ascending vestibular and auditory pathways including the inner ear, eighth nerve, and vestibular and cochlear nuclei in the brainstem can cause audiovestibular loss with acute vertigo and hearing loss. The aim of this review is to highlight the recent advances in understanding audiovestibular loss of a vascular cause and to address its clinical significance. It is usually associated with other neurological symptoms or signs, but can rarely occur in isolation (i.e., labyrinthine infarction). Among the vascular causes, ischemic stroke in the territory of the anterior inferior cerebellar artery (AICA) is known to be the leading cause of acute audiovestibular loss.
![aica and pica syndrome aica and pica syndrome](https://i.ytimg.com/vi/6fUnHIHVnBM/hqdefault.jpg)
Many neurological or neurotological conditions including viral inflammations, vascular insults, trauma, hereditary or genetic causes, bacterial meningitis, connective tissue disorders, or metabolic derangements should be considered in the differential diagnosis of audiovestibular loss. The required signs for diagnosing audiovestibular loss are canal paresis (CP) to caloric stimulation and sensorineural hearing loss on pure tone audiogram. It is characterized by acute onset of prolonged (lasting days) vertigo and hearing loss. Keywords: Audiovestibular loss Vertigo Hearing loss Stroke Anterior inferior cerebellar artery ProdromeĪcute audiovestibular loss is one of the most common neurotological dysfunctions in patients presenting with acute vertigo. This review aims to highlight the recent advances in understanding audiovestibular loss of a vascular cause and to address its clinical significance. A clinician should consider the possibility that acute audiovestibular loss may herald impending AICA territory infarction, especially when patients have basilar artery occlusive disease close to the origin of the AICA on brain MRA. As audiovestibular loss may precede the central symptoms or signs of an ischemic stroke in the posterior circulation, early diagnosis and proper management of audiovestiubular loss may provide a window to prevent the progression of infarction to larger areas of the posterior circulation. Unlike inner ear dysfunction of a viral cause, which can commonly present as an isolated vestibular (i.e., vestibular neuritis) or cochlear loss (i.e., sudden deafness), labyrinthine dysfunction of a vascular cause rarely results in isolated loss of vestibular or auditory function. So far, eight subgroups of AICA territory infarction have been identified according to the patterns of audiovestibular dysfunctions, among which the most common pattern is the combined loss of auditory and vestibular functions. Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be the leading cause of acute audiovestibular loss. Acute audiovestibular loss is characterized by abrupt onset of prolonged (lasting days) vertigo and hearing loss.