Superior Cerebellar Artery Territory Infarction

Abstract

We prospectively reviewed the clinical and neuroimaging features of 10 men and 7 women (aged 25-81) with recent superior cerebellar artery territory infarctions. Six patients had superior cerebellar artery infarctions restricted to one cerebellar hemisphere. The remaining patients had infarctions in more than one vascular territory (6 had bilateral superior cerebellar artery infarctions; 4 associated brainstem infarctions; 3 associated supratentorial infarctions and 5 infarctions in other cerebellar vascular territories). Presumptive etiologies were: 7 atherothrombotic, 6 cardioembolic (3 had atrial fibrillation, 1 with a left atrial thrombus; 2 had myocardial infarctions, 1 with a left ventricular thrombus; 1 had a paradoxical embolus with Ebstein''s anomaly and atrial septal defect), 2 vertebral artery dissection and 2 undetermined cause. Two patients died. Two patients suffered major morbidity; 1 developed hydrocephalus requiring ventricular shunting and the other had brainstem compression requiring emergent posterior fossa decompression. Superior cerebellar artery infarctions result from a number of causes, but are usually of presumptive atherothrombotic or cardioembolic origin. Although other reports suggest a benign course with superior cerebellar artery infarctions, they can be associated with serious morbidity or death.

Cerebellar infarction. Clinical and anatomic observations in 66 cases.

“…Although rare instances of poor prognosis in SCA infarcts have been documented,'1215 they are generally due to either accompanying brain stem infarction resulting from distal basilar artery occlusion2 '12,32 or the presence of multiple, bilateral cerebellar and supratentorial infarcts. 15 The usually benign course of isolated, unilateral SCA distribution cerebellar infarcts in our series correlated with small partial lesions of the superior cerebellar surface with minimal or no mass effect. Similar observations were recently reported by Amarenco et a126 in a series of nine cases of cerebellar infarction in the distribution of the lateral branch of the SCA.…”

Vertebrobasilar Occlusive Disease: Review of Selected Aspects

“…The most common recipient arteries are the SCA (more than 70% o f cases) [34,35], less frequently the PICA (equally divided in cardiocmbolic and atherosclerotic causes) [33. 36] and rarely the AICA.…”

“…Arterial occlusions leading to infarcts in the SCA distribution usually involve the distal lip of the basilar artery, the intracranial vertebral artery and less frequently the SCA itself [2,[33][34][35]. However, in most patients with SCA infarcts no arterial occlusion is found.…”

“…Every au topsy and clinical series concerned with SCA infarcts emphasizes cardiogenic embolism as the most common cause of SCA infarction, whatever the extent of the infarct [2, 33-35. 44], Cardiac sources of emboli have been found in 35-70% of cases [33][34][35], Sometimes the responsible infarct mechanism is artery-to-arterv embolism, arising from atherosclerotic occlusion of the basilar artery or from ulcerated plaques in the aortic arch [2] or vertebral artery dissection [4 1], Atherosclerotic occlusion occurs in 30% of cases [34], In the young, rare causes of infarction include SCA dissection and fibromuscular dysplasia [45], migrane [46][47][48] and transcardiac ('paradoxical') embo lism via a patent foramen ovale usually during Valsalva maneuver [44], AICA. The arterial occlusion usually involves the lower basilar artery and less frequently the distal portion of the intracranial vertebral artery beyond the PICA ostium in AICA plus infarcts [7,8].…”

Which Arterial Territory is Involved?

“…They usually supply the dorsolateral midbrain and have branches to the superior cerebellar peduncle and superior surface of the cerebellar hemispheres. 98,99 In these cases, headache, limb and gait ataxia, dysarthria, vertigo and vomiting are most prominent, but cases with some of these deficits in isolation have been reported, due to occlusion of the distal branches. In its pure form, it is rare.…”