Case report
Acute bilateral cerebellar infarction in the territory of the medial branches of posterior inferior cerebellar arteries

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Abstract

The most frequent type of cerebellar infarcts involved the posterior inferior cerebellar artery (PICA) and superior cerebellar artery territories but bilateral involvement of lateral or medial branches of PICA is extremely rare. In this report, we present a 55-year-old male who admitted to hospital with vomiting, nausea and dizziness. On examination left-sided hemiparesia and ataxic gait were detected. Infarct on bilateral medial branch of PICA artery territories was found out with cranial magnetic resonance imaging (MRI) technique and 99% stenosis of the left vertebral artery was found out with digital subtraction arteriography. The patient was put on heparin treatment. After 3 weeks, his complaints and symptoms had disappeared except for mild gait ataxia.

Introduction

Cerebellar infarctions usually occur in the territories of posterior inferior cerebellar artery (PICA) and superior cerebellar artery [1]. Among PICA infarctions occlusion of medial and lateral branches are rare and had good prognosis [2]. Occlusion of distal medullary branches of PICA, including the medial branch (mPICA) causes vertigo with or without ipsilateral axial lateropulsion and other types of cerebellar ataxias. Only a few clinicopathological and clinicoradiological studies of infarcts in territory of medial branches of PICA have been reported [3], [4]. We describe a clinicoradiological study of a patient with bilateral mPICA infarction.

Section snippets

Case report

A 55-year-old man was admitted to our hospital with transient, sudden loss of consciousness. His past medical history revealed coronary by-pass grafting 2 weeks ago on left anterior descending coronary artery. On admission to hospital he was oriented. His blood pressure was 160/70 mmHg and pulse rate was 76 min−1. No carotid bruit could be detected. On neurological examination, left-sided homonymous hemianopia, central facial palsy, hemiparesis and hemineglect were detected. Cranial

Discussion

Infarcts in the territory of bilateral medial branches of PICA are usually presented with vertigo, gait ataxia and attacks of nausea, vomiting and vertigo [3], [4]. Clinical and radiographic findings of our patient were consistent with bilateral medial PICA infarct. Several possibilities were considered regarding the pathogenesis of this cerebellar infarct, (1) two PICAs arising from an occluded basillary artery; (2) both medial branches of the PICAs arise from the PICA on one side; (3) two

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