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Case Report: What is Your Differential Diagnosis for Bilateral Cerebellar Infarct?
Connecticut Medicine
|May 22, 2018
Summary
A rare neurovascular variant involving the posterior inferior cerebellar arteries (PICA) led to stroke in a patient. Prompt intervention and surgical management resulted in a full recovery without neurological deficits.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Neurovascular variants are uncommon and infrequently discussed in general medical literature.
- Atypical neurovascular structures can lead to unusual clinical presentations and imaging findings in cases of infarction.
Observation:
- A 63-year-old male with hypertension, diabetes, and a history of tobacco use presented with severe headache, nausea, vomiting, and diplopia.
- Initial CT revealed acute ischemic changes in the bilateral posterior inferior cerebellar artery (PICA) territory.
- 3D time-of-flight magnetic resonance angiography (MRA) showed an abrupt cutoff of the right PICA and apparent absence of the left PICA.
Findings:
- The patient's presentation was attributed to an infarction secondary to a rare PICA variant.
- The anatomical anomaly involved an azygous right PICA and presumed absence of the left PICA.
Implications:
- This case highlights the importance of recognizing rare neurovascular variants in the differential diagnosis of stroke.
- Early diagnosis and appropriate management, including surgical intervention for hydrocephalus and stroke, are crucial for favorable outcomes.
- Understanding these variants is essential for accurate interpretation of neuroimaging and effective patient care.
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