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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Incidence and clinical features of acute multiple small cerebellar infarction
Ling Yu1, Xuanting Li2, Yutong Hou2
1Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, PR China.
Objective:
To investigate the clinical and imaging features and to identify possible etiology of acute multiple small cerebellar infarction (MSCI).
Methods:
We retrospectively enrolled 220 patients with acute cerebellar infarction, divided them into MSCI and large cerebellar infarction (LCI) groups, according to the quantity and size of lesions confirmed by MRI analysis. Clinical and imaging features were compared between the two groups to explore the possible etiology and pathogenesis.
Results:
Among 220 patients, 90 patients presented MSCI symptoms. The proportions of extracerebellar lesions (P = 0.001) and bilateral infarction (P = 0.001) in the MSCI group were higher than those in the LCI group. No significant differences were found in terms of age, gender, and common vascular risk factors between the two groups. The proportions of vertigo and headache in the MSCI group were significantly lower than those in the LCI group (P < 0.000 and 0.034, respectively), and limb weakness was significantly higher (P = 0.039) in the MSCI patients. Moreover, the proportions of nystagmus and ataxia in the MSCI group were significantly lower than those in the LCI group (P < 0.043 and 0.003, respectively). The MSCI group had higher proportions of ACA and MCA stenosis, while the proportion of posterior circulation stenosis was similar between the two groups. Infarctions involving the posterior inferior cerebellar (PICA) region and mixed territories were far more frequent than those involving the anterior inferior cerebellar artery (AICA) region and superior cerebellar artery (SCA) territory (P < 0.05). Large-artery atherosclerosis and multiple plus undetermined etiology were the main etiological factors of MSCI.
Conclusion:
In patients with acute cerebellar infarction, 30% of patients presented with MSCI. MSCI and LCI showed similar vascular risk factors and vascular stenosis in the posterior circulation system. Patients with MSCI should pay more attention to evaluating anterior circulation vessels' anatomy. Large-artery atherosclerosis was the main pathogenesis of acute MSCI. Assessment of cerebral vessels might be critically required in patients with MSCI complicated atrial fibrillation.
Insights
Acute multiple small cerebellar infarction (MSCI) affects 30% of patients with cerebellar infarction. Large-artery atherosclerosis is a key cause, with anterior circulation stenosis being more prevalent in MSCI cases. Further evaluation of cerebral vessels is crucial for these patients.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Cerebellar infarction presents a spectrum of clinical and imaging findings.
- Distinguishing between multiple small cerebellar infarctions (MSCI) and large cerebellar infarctions (LCI) is important for understanding etiology and prognosis.
Purpose of the Study:
- To investigate the clinical and imaging characteristics of acute multiple small cerebellar infarction (MSCI).
- To identify the potential causes and pathogenesis of MSCI.
- To compare MSCI with large cerebellar infarction (LCI).
Main Methods:
- Retrospective analysis of 220 patients with acute cerebellar infarction.
- Classification into MSCI and LCI groups based on MRI findings.
- Comparison of clinical and imaging features, including vascular risk factors and vessel stenosis.
Main Results:
- MSCI accounted for 30% of cases (90/220 patients).
- MSCI patients showed higher rates of extracerebellar and bilateral lesions, with more limb weakness but less vertigo and headache compared to LCI.
- Anterior circulation stenosis (ACA, MCA) was more common in MSCI, while posterior circulation stenosis was similar between groups. Large-artery atherosclerosis was the primary etiology.
Conclusions:
- MSCI and LCI share similar vascular risk factors and posterior circulation stenosis patterns.
- Evaluation of anterior circulation vessels is critical for MSCI patients.
- Large-artery atherosclerosis is the main driver of acute MSCI, necessitating thorough cerebral vessel assessment, especially in those with atrial fibrillation.
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