Frequency and Clinical Significance of Acute Bilateral Cerebellar Infarcts

Abstract

Background: Unlike acute unilateral cerebellar infarct (UCI), acute bilateral cerebellar infarcts (BCI) have attracted little attention. To evaluate the clinical significance of BCI, we compared UCI and BCI and analyzed potentially prognostic factors. Methods: Patients who were consecutively admitted at a university hospital over a 4-year period with acute cerebellar infarcts, proven by diffusion-weighted imaging, were studied. Cerebellar infarcts were topographically classified, and divided into 2 groups: UCI and BCI. The demographics, involved territories, concomitant lesions outside the cerebellum (CLOC), bilateral involvement, infarct volume, hospital courses, and mechanisms were analyzed. We performed multiple regression analysis to predict the poor outcome at discharge [≧3 on the modified Rankin Scale (mRS)]. Results: Among 162 patients with acute cerebellar infarcts, 31% (n = 50) were BCI. Territorial infarcts were 74% (n = 120) and non-territorial infarcts 26% (n = 42) of the total. Posterior inferior cerebellar artery infarcts were the most common, and combined-territorial infarcts were the rarest. Baseline demographics were not significantly different between UCI and BCI, except for initial stroke severity (modified NIH Stroke Scale and infarct volume) and diabetes. Large-artery atherosclerosis was significantly higher in BCI, whereas undetermined causes were higher in UCI (p = 0.028). By multiple regression analysis, BCI was the only independent radiological factor for poor prognosis (odds ratio, 6.96; 95% CI, 1.80–26.92), and represented a significantly more unstable hospital course, longer hospital stay, worse mRS at discharge, and higher mortality. Conclusions: In acute cerebellar infarcts, bilateral involvement is common and appears to be a superior determinant for early prognosis rather than territories involved or CLOC.

Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts

“…A recent study on consecutive series of cerebellar infarcts showed that cerebellar infarcts at the post-vertebrobasilar junction (anterior inferior cerebellar artery and superior cerebellar artery territory) were more common on the left side. This study also indicated that there was a right predilection at the pre-vertebrobasilar junction (PICA territory) and a left predilection at the post-vertebrobasilar junction (superior cerebellar artery territory) even in patients with combined involvements of cerebellar arterial territories 23. For these reasons, our findings may provide more evidence that the specific location of infarcts is closely connected to BA curvature or VA hypoplasia.…”

The Usefulness of the TOAST Classification and Prognostic Significance of Pyramidal Symptoms During the Acute Phase of Cerebellar Ischemic Stroke

“…Our study confirms data from the literature showing more frequent cerebellar ischemic stroke among men [ 1 , 2 , 15 ]. As in ischemic stroke, the primary factors of cerebellar infarction are hypertension and atrial fibrillation.…”

“…Ischemic cerebellar infarction is a rare condition and accounts for between 1.5 % and 20 % of all ischemic strokes. It is common between the fifth and eighth decades of life, with men aged 60 to 65 being affected more often than women [ 1 – 5 ]. The risk factors for cerebellar stroke are the same as for strokes in other areas of the brain.…”

Cerebellar Stroke

“…Clinical features of bilateral cerebellar infarcts result from bilateral disturbances of cerebellar function, a high prevalence of brainstem compression, and bilateral depression of cerebral function by cerebello-cerebral diaschisis. Compared with unilateral infarcts, patients with bilateral lesions have a more severe or fluctuating clinical course and a poorer outcome and need more intracranial pressure-lowering therapy (Hong et al 2008). The characteristics of bilateral cerebellar infarction are similar to those of unilateral cerebellar infarction, but the stroke mechanism is more likely to be large artery atherosclerosis, and they have a higher rate of stroke recurrence (Petty et al 2000;Hong et al 2008).…”