A patient presented to the clinic with deafness and tinnitus in his right ear. On examination he was found to have right sided facial paralysis and loss of taste sensation on the anterior half of the right side of the tongue. Which of the following aery is most likely to be occluded in this patient?
A patient presented to the clinic with deafness and tinnitus in his right ear. On examination he was found to have right sided facial paralysis and loss of taste sensation on the anterior half of the right side of the tongue. Which of the following aery is most likely to be occluded in this patient?
💡 Explanation
## **Core Concept**
The patient's symptoms suggest a lesion affecting the facial nerve (cranial nerve VII), which controls facial expressions, taste sensation on the anterior two-thirds of the tongue, and has a branch to the stapedius muscle in the middle ear. The combination of deafness, tinnitus, facial paralysis, and loss of taste on the anterior half of the tongue indicates involvement of the facial nerve and the vestibulocochlear nerve (cranial nerve VIII).
## **Why the Correct Answer is Right**
The correct answer involves the artery that supplies the facial nerve and the vestibulocochlear nerve. The **labyrinthine artery**, a branch of the **anterior inferior cerebellar artery (AICA)** or sometimes directly from the **basilar artery**, supplies the inner ear structures including the cochlea and vestibule, and also gives off branches to the facial nerve. Occlusion of this artery can lead to the symptoms described: hearing loss (deafness) and tinnitus due to cochlear involvement, facial paralysis due to involvement of the facial nerve, and loss of taste on the anterior half of the tongue.
## **Why Each Wrong Option is Incorrect**
- **Option A:** The **Posterior Cerebral Artery (PCA)** primarily supplies the occipital lobe and is not directly associated with the symptoms described. It does not supply the structures innervated by cranial nerves VII and VIII.
- **Option B:** The **Superior Cerebellar Artery (SCA)**, another branch of the basilar artery, mainly supplies the superior part of the cerebellum. While it is involved in cerebellar functions, it is not typically associated with the cranial nerves VII and VIII.
- **Option D:** The **Posterior Inferior Cerebellar Artery (PICA)** usually supplies the inferior part of the cerebellum. Like SCA, it does not directly relate to the symptoms described, which are associated with cranial nerves VII and VIII.
## **Clinical Pearl / High-Yield Fact**
A key clinical correlation to remember is that the **labyrinthine artery** is often a branch of the AICA and its occlusion can cause a range of symptoms including vertigo, hearing loss, tinnitus, and facial weakness, collectively known as **ipsilateral vestibulocochlear and facial neuropathy**. This presentation is highly suggestive of a stroke or infarction in the vertebrobasilar circulation.