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Table of Contents    
LETTER TO EDITOR
Year : 2015  |  Volume : 63  |  Issue : 6  |  Page : 988-989

Unilateral hearing loss: An unusual presentation of an undiagnosed giant vertebrobasilar artery aneurysm


Department of Neurological Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia

Date of Web Publication20-Nov-2015

Correspondence Address:
Atef Ben Nsir
Department of Neurological Surgery, Fattouma Bourguiba University Hospital, Monastir
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.170113

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How to cite this article:
Nsir AB, Boughamoura M, Kilani M, Hattab N. Unilateral hearing loss: An unusual presentation of an undiagnosed giant vertebrobasilar artery aneurysm. Neurol India 2015;63:988-9

How to cite this URL:
Nsir AB, Boughamoura M, Kilani M, Hattab N. Unilateral hearing loss: An unusual presentation of an undiagnosed giant vertebrobasilar artery aneurysm. Neurol India [serial online] 2015 [cited 2019 Dec 15];63:988-9. Available from: http://www.neurologyindia.com/text.asp?2015/63/6/988/170113


Sir,

A 62-year-old retired instrumentation technician presented with a 5-year long history of progressive left sided hearing loss with recent, rapid aggravation following severe occipital pain and dizziness. He had been operated for symptomatic pheochromocytoma 1½ years back. He recovered satisfactorily with normalization of his blood pressure following excision of the pheochromocytoma.

Neurological examination revealed hyper-reactive deep tendon reflexes in all four limbs, and the pure tone audiogram confirmed left retro-cochlear hearing impairment.

Magnetic resonance imaging and magnetic resonance angiography showed a giant fusiform aneurysm of the vertebrobasilar artery with an uncommon course of the basilar artery resulting in severe brain stem compression on the left side [Figure 1]. These findings were confirmed by cerebral angiography, which clearly delineated the limits of the aneurysmal dilatation extending from the V4 segment of the left vertebral artery right up to the posterior cerebral arteries [Figure 2].
Figure 1: Magnetic resonance imaging, axial and coronal T1.weighted post.gadolinium views, and coronal T2.weighted image showing a giant fusiform aneurysm of the vertebrobasilar artery with an unusual course of the basilar artery resulting in severe brain stem compression on the left side

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Figure 2: Cerebral angiography, lateral and anteroposterior view, clearly delineating the limits of the aneurysm, which extended from the V4 segment of the left vertebral artery to the posterior cerebral arteries

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Because of its size and the fact that the aneurysm had incorporated the origins of both posterior cerebral arteries, it was neither suitable for direct surgical clipping nor for endovascular coiling. An endovascular procedure using an intraluminal stent to maintain the patency of the vessel, along with strategic coiling of the aneurysmal sac while maintaining the origin of the side branches and important perforators, was proposed, but the patient refused any intervention.

His headache and dizziness regressed after symptomatic medication, and his clinical status remained unchanged at 6 years after the diagnosis of the aneurysm.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1], [Figure 2]



 

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