Infarct cerebellar

FIGURE 4.2 (Continued) A compliant balloon was used to perform angioplasty (c). Postangioplasty angiogram demonstrated complete recanalization of the basilar artery and its major branches (d and e). MRI performed 2 days later demonstrated only small areas of infarction in the cerebellar hemispheres (arrows—f and g) but no brainstem or occipital infarcts. 

FIGURE 6.4 (a) Seventy-eight-year-old woman presenting with new onset vertigo and gait unsteadiness. Hypoattenuation of the left cerebellar hemisphere consistent with infarction, (b) Postoperative CT after suboccipital craniectomy and partial resection of the left cerebellar hemisphere. 

Laun A, Busse O, Calatayud V, Klug N. Cerebellar infarcts in the area of the supply of the pica and their surgical treatment. Acta Neurochir (Wien) 1984 71 295-306. 

Jauss M, Krieger D, Hornig C, Schramm J, Busse O. Surgical and medical management of patients with massive cerebellar infarctions results of the German-Austrian cerebellar infarction study. J Neurol 1999 246 257-264. 

Tohgi H, Takahashi S, Chiba K, Hirata Y. Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. The Tohoku Cerebellar Infarction Study Group. Stroke 1993 24 1697-1701. 

Tulyapronchote R, Malkoff MD, Selhorst JB, Gomez CR. Treatment of cerebellar infarction by decompression suboccipital craniectomy. Stroke 1993 24 478 80. 

In a multicenter study, Jauss et al. °° evaluated the clinical features of 84 cerebellar infarction patients, and found that poor outcome was associated with a decreasing level of consciousness after clinical deterioration. Half of the patients in this study who deteriorated to coma had a meaningful recovery after undergoing ventricular drainage or suboccipital decompression, but unfortunately the trial was not randomized or controlled. 

An alternative method of managing patients with cerebellar infarction causing obstructive hydrocephalus is endoscopic third ventriculostomy. Baldauf et al. ° reviewed 10 cases managed by the use of endoscopic third ventriculostomy, 8 of whom had clinical improvement (measured as an improvement in the level of consciousness). This therapy is still experimental, and improvement in outcome has not been demonstrated. 

Auer LM, Auer T, Sayama I. Indications for surgical treatment of cerebellar hemorrhage and infarction. Acta Neurochir (Wein) 1986 79 74-79. 

Koh MG, Phan TG, Atkinson JL, Wijdicks EFM. Neuroimaging in deteriorating patients with cerebellar infarcts and mass effect. Stroke 2000 31(9) 2062-2067. 

TanedaM, HayakawaT, Mogami H. Primary cerebellar hemorrhage quadrigeminal cistern obliteration on CT scans as a predictor of outcome. J Neurosurg 1987 67(4) 545-552. Raco A, Caroli E, Isidori A, Salvati M. Management of acute cerebellar infarction one institution s experience. Neurosurgery 2003 53(5) 1061-1065. 

With involvement of the cerebellar hemisphere supplied by the PICA, subsequent edema may cause obstruction of the 4th ventricle, hydrocephalus or compression of the medulla oblongata. Clinically, involvement of the entire cerebellar hemisphere can not be distinguished from partial cerebellar infarction (Amarenco and Hauw 1990). Therefore patients with neurological symptoms suggesting infarction within the PICA territory require neuroimaging studies and close clinical monitoring. 

Isolated cerebellar infarction withoutinvolvement of the medulla is often difficult to identify, since gait ataxia, vomiting and dizziness may not be accompanied by typical brainstem symptoms (Barth et al. 1994). Cerebellar edema may compress the medulla and the pons leading to conjugate eye deviation to the side opposite the lesion without contralateral hemiparesis. This sign is probably pathognomonic for severe cerebellar mass effect and requires immediate intervention. 

Amarenco P, Hauw JJ (1990) Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. A clinico-pathological study of 20 cases. Brain 113 139-155 Baquis GD, Pessin MS, Scott RM (1985) Limb shaking - a carotid TIA. Stroke 16 444-448 Barth A, Bogousslavsky J, Regli F (1994) Infarcts in the territory of the lateral branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 57 1073-1076 Baumgartner RW, Sidler C, Mosso M et al (2003) Ischemic lacunar stroke in patients with and without potential mechanism other than small-artery disease. Stroke 34 653-659... 

The mesencephalon has four arterial territories anteromedial (paramedian branches of the basilar artery anterolateral (branches from the P2 segment of the PCA) lateral (branches from P2 segment of PCA and from posterior choroidal arteries) and dorsal (branches from PI segment of PCA and superior cerebellar artery). Isolated mesencephalic infarcts are rare because the arteries supplying blood to the mesencephalon (basilar artery, posterior cerebral artery and superior cerebellar artery)... 

Medullary infarcts can be medial, lateral or combined (Fig. 14.6). The medial territory is supplied by penetrating vessels from the anterior spinal artery and the distal vertebral artery. The lateral territory main arterial supply comes from penetrating arteries from the distal vertebral artery and the posterior inferior cerebellar artery. The small posterior territory is supplied by the posterior spinal artery and the posterior inferior cerebellar artery. Medial... 

Cerebellar infarcts can be grouped in territorial (superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery and combined), borderzone and lacunar. They are often combined with brain stem infarcts and with superficial posterior cerebral artery or thalamic infarcts. The most common isolated cerebellar infarcts are located in the superior cerebellar artery and posterior inferior cerebellar artery territories (Amarenco 1993 Amarenco et al. 1993,1994). 

Brainstem, cerebellar, thalamic or occipital lobe signs normally indicate infarction in the distribution of the vertebrobasilar circulation or a localized hemorrhage. 

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