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CASE REPORT
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 48-49

Acute Bilateral Cerbellar and Brain Stem Infarction in The Territory of The Medial Branches of Posterior Inferior Cerebellar Arteries


1 Senior Resident, Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
2 Assistant Professor, Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
3 Associate Professor, Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India

Correspondence Address:
Kalyan Kumar Saha
Senior Resident, Department of General Medicine, Indira Gandhi Institute of Medical Sciencs, Sheikhpura, Patna -14
India
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Source of Support: None, Conflict of Interest: None


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We repot a rare case of acute bilateral cerebellar and brain stem infarction confined to the territory of the medial branches of the posterior inferior cerebellar arteries. The diagnosis was based on clinical and radiological examination. Case Description A known hypertensive 66-year old female presented with sudden onset of headache, vertigo, followed by brief loss of consciousness. Cranial computed tomographic scan showed edema in bilateral medial cerebellar zone and brainstem suggestive of acute ischemic infarction. On examination the patient showed mild dysarthria, dysequilibrium with retropulsion, symmetrical bilateral horizontal gaze evoked nystagmus on lateral gaze, and marked gait ataxia with brain stem signs, followed by marked vertigo that was induced by motion. Her blood pressure was recorded to be 190/110mmHg in right arm. The patient improved with conservative therapy, including intravenous administration of mannitol. Conclusions We suspect that our patient likely had initial transient occlusion of the right vertebral artery at the origin of the right posterior inferior cerebellar artery, which probably gave rise to the bilateral medial branches of posterior inferior cerebellar arteries. This caused infarction in the territory of the medial branches on both sides with brain stem signs. Such an unusual pattern of cerebellar infarction accompanied by brain stem sign posed a diagnostic challenge in the ward, and correct diagnosis was facilitated by cranial computed tomography.


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