The anterior inferior cerebellar artery arises from the lower third of the basilar artery and courses around the pons toward the internal auditory meatus, where it often loops into the meatus alongside the facial and vestibulocochlear nerves. It supplies the lateral inferior pons, the anterior inferior cerebellum, and crucially gives rise to the labyrinthine (internal auditory) artery supplying the inner ear.
AICA occlusion produces the lateral inferior pontine syndrome with ipsilateral facial palsy, hearing loss, vertigo, and facial numbness combined with contralateral spinothalamic loss. The labyrinthine artery from the AICA is the only blood supply to the cochlea and vestibular apparatus, making it extremely sensitive to ischaemia: sudden sensorineural hearing loss can be a manifestation of AICA ischaemia and should prompt MRI and vascular risk assessment. AICA is one of the vessels that can contact the facial nerve REZ causing hemifacial spasm.
AICA territory infarction from basilar or AICA thromboembolism causes sudden onset hearing loss, vertigo, facial weakness, and facial numbness (ipsilateral) with contralateral body temperature loss, a devastating presentation requiring urgent MRI and neurovascular assessment.
Ischaemia of the labyrinthine artery from AICA disease causes sudden unilateral cochlear deafness and vestibular dysfunction indistinguishable from viral labyrinthitis on presentation, requiring MRI to exclude posterior fossa ischaemia, particularly when associated with neurological symptoms.
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