MRI of Cerebellar Infarction

Abstract

Background: MRI is the imaging modality of choice for diagnosing brain infarction. Because of few or atypical clinical symptoms and a relatively low sensitivity of CT scans, many cerebellar infarctions may be detected only with MRI. With adequate recognition of cerebellar infarction on MRI and prompt initiation or optimisation of preventive therapeutic measures, more dramatic strokes may be avoided in selected cases. Summary: We first briefly review the clinical presentation of cerebellar infarctions, followed by a short refresher on cerebellar anatomy and pathophysiological mechanisms of cerebellar infarcts. Then, we review the arterial cerebellar perfusion territories recently made visible with territorial arterial spin labeling (ASL), followed by a discussion and illustration of the MRI appearance of cerebellar infarcts in different stages. Similar to large cerebellar infarcts, recent studies investigating volumetric MRI datasets have now shown that small cerebellar infarcts occur in typical spatial patterns, knowledge of which may help in the diagnosis of even the smallest of cerebellar infarcts on MRI. Key Messages: MRI is the modality of choice for diagnosing cerebellar infarction. The posterior inferior cerebellar artery (PICA)-territories can be visualised with super-selective territorial ASL MRI. The PICA supplies at least the medial part of the posterior cerebellar surface. Anterior inferior cerebellar artery-infarcts can be mistaken for lateral PICA-infarcts. Small infarcts typically affect the cortex and often present as incidental cavities. Subacute cerebellar infarcts may be missed on imaging due to a phenomenon called “fogging.”

Small obliquely oriented cortical cerebellar infarctions are associated with cardioembolic stroke

“…In recent studies analyzing small, asymptomatic, chronic CI (resembling what we called SCCI in our study), association with markers of atherothrombotic cerebrovascular disease was observed suggesting artery-to-artery embolic origin of these cerebellar cortical cavities [11–16]. However, in these studies no details were given on the proportion of patients having had ≥24 h ECG monitoring (to detect the most frequent cause of cardioembolism, i.e.…”

“…Another study showed cortical cerebellar microinfarctions in one third of patients with recent symptomatic vertebral artery stenosis [12]. These data suggest that these cortical cerebellar cavities are related to artery-to-artery embolism [11–16].…”

Bilateral middle cerebellar peduncle lesions: Neuroimaging features and differential diagnoses

“…Anatomical variations are most commonly seen as caudal AICA atresia or rostral duplicate AICA occlusion (Chen, Chen, Diaz‐Marchan, Schomer, & Kumar, 2018). Moreover, the territory perfused by the AICA may overlap with that of the marginal branch of the superior cerebellar artery (SCA); thus, the MCPs could be supplied by the SCA directly or by a watershed zone supplied by both vascular territories in patients with an AICA variation (De Cocker, Lövblad, & Hendrikse, 2017; Kataoka, Izumi, & Kinoshita, 2011; Rhoton, 2000). Moreover, some studies reported that bilateral MCP infarctions could be attributed to varying degrees of vertebral artery occlusion or stenosis (De Cocker et al., 2017; John, Hegazy, Cheng Ching, & Katzan, 2013).…”

“…Symmetrical hyperintensity of both MCPs on T2-weighted imaging (f) suggests Wallerian degeneration of the pontocerebellar fibersSchomer, & Kumar, 2018). Moreover, the territory perfused by the AICA may overlap with that of the marginal branch of the superior cerebellar artery (SCA); thus, the MCPs could be supplied by the SCA directly or by a watershed zone supplied by both vascular territories in patients with an AICA variation (De Cocker, Lövblad, & Hendrikse, 2017;Kataoka, Izumi, & Kinoshita, 2011;Rhoton, 2000).Moreover, some studies reported that bilateral MCP infarctions could be attributed to varying degrees of vertebral artery occlusion or stenosis(De Cocker et al, 2017;John, Hegazy, Cheng Ching, & Katzan, 2013). Therefore, alterations in the vertebrobasilar system, especially the AICA, should be considered as a possible cause of isolated bilateral MCP infarctions.…”

Effects of Edaravone on Neurological Function and Tumor Necrosis Factor Alpha and Interleukin 8 Levels in Patients with Cerebral Infarction

“…The inclusion criteria were as follows: patients diagnosed with cerebral infarction based on transcranial magnetic resonance imaging or computed tomography scan findings [12], those with stable vital signs who were admitted to the hospital within 48 h after the onset of cerebral infarction, those with detailed general clinical data and expected survival time ≥3 months, and those with firstepisode cerebral infarction or recurrent cerebral infarction that did not cause any neurologic impairment. This study was approved by the Ethics Committee of the Second Hospital of Hebei Medical University.…”