Abstract
A 45-year-old woman presented with sudden onset vertigo, left hypoacusis, and tinnitus, consistent with acute unilateral audiovestibular loss. Bedside examination revealed a left sided sensorineural hearing loss and leftward falling gait. Left peripheral vestibular hypofunction was confirmed acutely on video head impulse testing characterised by reduced vestibular-ocular reflex gains with overt catch-up saccades in the left horizontal and posterior semicircular canals. Acoustic reflexes were absent on the left side. Pure tone audiometry confirmed a profound left sensorineural hearing loss, with no measurable hearing threshold in the left ear. An MRI brain with diffusion weighted imaging performed after 24 hours was unremarkable. Repeat MRI of the internal acoustic canal (IAC) on day 7 demonstrated increased T1 and FLAIR signal throughout the left cochlear and semicircular canals, without contrast enhancement. A diagnosis of labyrinthine haemorrhage was made. Extensive testing for coagulopathies and vasculitides was negative. On long-term follow-up the patient remained profoundly deaf, however balance and vestibular symptoms improved with early vestibular physical rehabilitation. This case highlights the importance of an inner ear MRI in presentations of acute audiovestibular loss, as well as the utility of ancillary audiovestibular testing. Labyrinthine haemorrhage may be missed on stroke-specific sequences
