双侧椎动脉V4段重度狭窄引起双侧小脑梗死一例

双侧小脑梗死是相对少见的脑梗死,临床表现类似于单侧小脑梗死,发病机制包括动脉粥样硬化性血栓形成、心源性栓塞及动脉到动脉栓塞等,本文报道双侧椎动脉V4段重度狭窄引起双侧小脑梗死一例。     

青年小脑梗死伴卵圆孔未闭1例报道及相关文献复习

急性头晕/眩晕是神经内科门急诊工作的常见病与多发病,患者往往伴有恶心呕吐、眼球震颤、行走不稳等症状,持续24 h以上者总称为急性前庭综合征(Acute vestibular syndrome,AVS)。AVS的病因多样,前庭神经炎、迷路炎等周围性因素以及后循环供血区脑卒中、幕下占位等中枢性因素均可引起。发生在青年人的AVS以周围性因素居多,病程往往存在一定的自限性,总体预后良好;然而极少数却是由后循环供血区缺血性脑卒中(Ischemic stroke,IS)引起,其病因学及治疗原则完全不同于周围性AVS,-旦漏诊有可能产生严重后果。     

孤立双侧桥臂梗死1例报道

桥臂亦称小脑中脚（middle cerebellar peduncle,MCP）,主要由小脑前下动脉（anterior inferior cerebellar artery,AICA）支配,小脑上动脉（superior cerebell arartery,SCA）也部分参与,而MCA主要供血范围为脑桥外侧、小脑中脚以及小脑前下侧。桥臂主要恒定由AICA的侧支供血。但因此处血供侧支丰富,很少发生梗塞。孤立的桥臂梗死少见,占急性脑梗死的0．12％,而孤立的双侧脑梗死更是鲜有报道。     

Acute bilateral inferior cerebellar infarction in a patient with neurosyphilis

BACKGROUND: Bilateral simultaneous infarction in the territories of the posterior inferior cerebellar arteries (PICAs) is rare but was recently reported with increasing frequency, probably because of the wider availability of magnetic resonance imaging. The cause of these infarcts is believed to be atherosclerotic or embolic occlusion of a dominant PICA, which perfused the territories of the medial branches of both PICAs. RESULTS: We encountered a patient with simultaneous infarction in the territories of the medial branches of both PICAs. The clinical course, imaging results, and laboratory findings are presented. The patient was diagnosed with neurosyphilis based on a history of chancre, positive serum and cerebrospinal serologies, cerebrospinal pleocytosis, and increased intrathecal immunoglobulin synthesis. We believe that meningovascular syphilis caused the bilateral cerebellar infarct via presumed thromboangiitis of a dominant PICA perfusing both cerebellar hemispheres. The patient was treated with intravenous high doses of penicillin. CONCLUSIONS: This case reminds us that meningovascular syphilis should be considered in younger patients with stroke. Patients with bilateral cerebellar infarction may solely have symptoms of vertigo and ataxia but can develop life-threatening complications because of edema of the infarcted tissue with resultant hydrocephalus and pressure on the brainstem.     

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

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.     

A case of bilateral cerebellar infarction in the distribution of the bilateral superior cerebellar artery]

We reported a case of bilateral cerebellar hemorrhagic infarction in the distribution of the bilateral superior cerebellar artery. A 58-year-old man suddenly developed dizziness and transient loss of consciousness. The neurological examination revealed left hearing disturbance, left sensory disturbance involving face, dysarthria and bilateral ataxia. This patient was considered to be classic clinical syndrome of right superior cerebellar artery. CT and MRI revealed hemorrhagic infarction corresponding to the full territory of the bilateral superior cerebellar artery. The right posterior cerebral artery was filling through the right posterior communicating artery on the right carotid angiography taken 2 hours after the onset. Bilateral vertebral angiography on the 18th day demonstrated no occlusions in the basilar artery and the bilateral superior cerebellar artery. Hemorrhagic infarction corresponding to the full territory of the bilateral superior cerebellar artery, sparing other territories as the present case, is extremely rare. In this case, cerebral embolism (top of the basilar syndrome) was suggested because of existence of atrial fibrillation and sudden onset.     

Acute bilateral cerebellar infarcts in the territory of posterior inferior cerebellar artery

The authors report 12 patients with acute bilateral cerebellar infarcts in posterior inferior cerebellar artery (PICA) territory. They found three topographic patterns: A) bilateral medial PICA in six patients; B) unilateral whole + contralateral medial PICA in four; and C) bilateral small multiple in two. Nine patients in Groups A and B had unilateral PICA or vertebral artery disease, and both patients in Group C had bilateral vertebral artery disease. These findings support that unilateral supply to both medial PICA territories may be the most relevant pathogenesis of this syndrome.     

Clinical outcome following surgical treatment for bilateral cerebellar infarction

Tsitsopoulos PP, Tobieson L, Enblad P, Marklund N. Clinical outcome following surgical treatment for bilateral cerebellar infarction.
Acta Neurol Scand: 2011: 123: 345–351.
© 2010 John Wiley & Sons A/S. Objectives – To analyze the initial clinical and radiological findings, the surgical treatment, and the clinical outcome following surgical decompression in patients with space‐occupying bilateral cerebellar infarction. Materials and Methods – Ten patients with expansive bilateral cerebellar infarction and decreased level of consciousness were operated with suboccipital craniectomy, removal of the infarcted tissue, and placement of external ventricular drainage. Long‐term outcome was assessed using the modified Rankin scale (mRS). Results – Mean Glasgow coma scale (GCS) score before surgery was 8.9 ± 3.3 and improved to 12.6 ± 3.6 at discharge. At the long‐term follow‐up (median 57.6 months), six patients had a favorable outcome (mRS 1.3 ± 0.8). Four patients, all with an associated brain stem infarct, had a poor outcome. Conclusions – In the absence of brain stem infarcts, surgical treatment resulted in a favorable clinical outcome and should be considered a treatment option for patients with expansive bilateral cerebellar infarction.     

Acute cerebellar infarction simulating posterior fossa tumor]

We report a case of space-occupying infarction of the left cerebellar hemisphere with occlusive hydrocephalus and left to right shift of the fourth ventricle. The patient, a 58 years old man, underwent shunting and decompressive craniectomy of the posterior fossa and survived without neurological deficits.     

A case of midbrain infarction with acute bilateral cerebellar ataxia]

An 81-year-old man was suffered from acute dysarthria and gait disturbance. Bilateral cerebellar ataxia and ataxic dysarthria were the only neurological findings. MRI images revealed an infarction in the lower and medial part of the midbrain. We consider that bilateral ataxia of the present case was caused by the lesion at the decussation of the superior cerebellar peduncle.