MRI mismatch-based intravenous thrombolysis for isolated cerebellar infarction

Cerebellar infarctions constitute a significant proportion of ischemic strokes and carry a substantial morbidity and mortality mainly because of swelling in the posterior fossa. No specific acute therapy is established, and patients are usually excluded from intravenous thrombolysis (IVT).

Two patients presented in an extended time window of 5 and 7 hours to our emergency department with sudden onset of severe cerebellar symptoms. After emergency MRI demonstrated superior cerebellar artery (SCA) occlusion with hypoperfusion of the respective territory and only minor DWI lesions, IVT was administered. Both patients recovered within a few hours after therapy and follow-up MRI on day 1 after treatment demonstrated only minor infarction.

We present to our knowledge the first cases of MRI mismatch-based IVT in an extended time window in patients with isolated SCA-infarctions. More studies are needed to evaluate IVT in this patient population. Modern imaging techniques might be helpful to select patients for therapy in posterior circulation strokes.