The labyrinthine artery (internal auditory artery) is a long, narrow branch that typically arises from the anterior inferior cerebellar artery (AICA), though in 15-20% of individuals it arises directly from the basilar artery. It accompanies the facial and vestibulocochlear nerves through the internal auditory canal to supply the cochlea, the vestibular labyrinth, and the cochlear nerve. It is a functional end artery with no anastomoses within the labyrinth.
Labyrinthine artery occlusion produces sudden complete unilateral sensorineural hearing loss and severe vertigo simultaneously, without neurological deficits when isolated. This combined audiovestibular loss should prompt urgent MRI as it may herald a posterior fossa stroke (AICA infarction) or represent the first manifestation of basilar artery thrombosis. Isolated labyrinthine infarction (without AICA territory brain infarction) is recognised as a cause of sudden hearing loss and may respond to systemic thrombolysis. The artery is at risk during acoustic neuroma (vestibular schwannoma) resection.
Sudden unilateral sensorineural hearing loss with simultaneous severe vertigo from labyrinthine artery occlusion can mimic viral labyrinthitis but indicates vascular aetiology, particularly when MRI diffusion-weighted imaging shows restricted diffusion in the labyrinth (cochlear stripe sign) or in the posterior fossa, warranting stroke work-up and anticoagulation.
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