Sudden sensorineural hearing loss (SSNHL) is uncommon, affecting approximately 20 in 100,000 people annually. The majority (90%) of cases are idiopathic. Intralabyrinthine hemorrhage (ILH) as a cause of SSNHL is exceptionally rare, with only a few case reports in literature. ILH is typically associated with vertigo and tinnitus. It is most commonly diagnosed with MRI, though its treatment and prognosis is poorly understood. A 79-year-old male presented with a 1-day history of unilateral hearing loss and positional vertigo associated with nausea and vomiting. He had a history of atrial fibrillation for which he was anticoagulated on apixaban. Otoscopy showed normal intact tympanic membranes bilaterally, normal head impulse, no nystagmus and a negative test of skew. His symptoms were managed with prochlorperazine. He was prescribed a 2-week course of oral corticosteroids and referred for urgent audiometry and MRI. Pure tone audiometry demonstrated profound hearing loss of the right ear, with normal tympanometry bilaterally. MRI of the internal auditory meatus demonstrated high T1 and FLAIR signal hyperintensity within the cochlea and semicircular canals with narrowing of the cochlear canal, suggestive of ILH. The patient was referred to an audiologist for fitting of hearing aids, as well as a vestibular physiotherapist. He was discharged with as needed follow up, and instructed to present early particularly if any hearing loss developed on the unaffected side. This case presents an extremely rare cause of SSNHL. It demonstrates the utility of audiometry and MRI in the assessment of patients with acute hearing loss and dizziness. Hyperintensity of labyrinthic fluid is a strong indicator of ILH. Anticoagulation and haematological coagulopathies are risk factors of ILH. However, infectious, immunologic, neoplastic or ototoxic aetiologies should also be considered.