Abstract
We present an unusual case of simultaneous bilateral cerebellar infarction in the territory of the medial and intermediate branches of the posterior inferior cerebellar arteries (mPICA). The patient, a 57-yr old woman, had no risk factors for cerebrovascular disease but a long-standing hypertension. Pathogenetic hypotheses of this unusual ischemic site of lesion may be referred to: A) two PICAs arising from an occluded basilar artery; B) both medial branches arising from the same PICA on one side; C) a haemodynamic mechanism with hypoperfusion in the most peripheral branches of the arteries; D) a double, simultaneous embolic stroke in mPICAs territory. Based on clinical course, supraortic duplex-scan, echocardiography, MRI, angioMRI and CT scans, and digital subtraction angiography, none of these hypotheses could be clearly associated with the pathogenesis of the lesion. Nevertheless, we propose that an anomalous common mPICA for both cerebellar territories should represent the necessary condition for the ischemic insult and, simultaneously, other factors should intervene as possible determining events.
Sommario
Descriviamo il caso di un infarto bilaterale nel territorio delle branche mediali della arteria cerebellare postero inferiore (mPICA). La paziente, una donna di 57 anni, non aveva fattori di rischio per cerebropatia vascolare, eccettuata una lunga storia di ipertensione arteriosa. Sono state formulate diverse ipotesi patogenetiche in grado di giustificare questo inusuale sito di lesione: A) due PICA che originino da una arteria basilare occlusa; B) entrambe le branche mediali che originino dalla stessa PICA in un lato; C) una genesi emodinamica con una ipoperfusione nelle branche più periferiche delle arterie; D) un doppio simultaneo stroke embolico nel territorio delle mPICA. Sulla base del decorso clinico e degli esami strumentali (Ecodoppler dei vv. epiaortici, ecocardiogramma, RM, angioRM, TC ed angiografia digitale intrarteriosa) nessuna di queste ipotesi può essere singolarmente considerata come responsabile della lesione. Proponiamo, quindi, che una anastomosi tra le PICA debba rappresentare la necessaria predisponente condizione sulla quale siano poi intervenuti ulteriori fattori determinanti l'evento ischemico acuto.
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Brusa, L., Iannilli, M., Bruno, G. et al. Bilateral simultaneous cerebellar infarction in the medial branches of the posterior inferior cerebellar artery territories. Ital J Neuro Sci 17, 433–436 (1996). https://doi.org/10.1007/BF01997719
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DOI: https://doi.org/10.1007/BF01997719