Massive cerebellar infarction caused by spontaneously isolated posterior inferior cerebellar artery dissection: A...

Diagnosing posterior inferior cerebellar artery dissection (PICAD) using radiological images is challenging. Massive cerebellar infarctions resulting from spontaneous, isolated PICAD are rare, and the associated clinical, imaging, and treatment options remain unclear.

A 39-year-old man was admitted for dizziness and unstable gait for two days. Physical examination revealed decreased right-limb muscle strength and right-sided ataxia. Brain magnetic resonance imaging (MRI) showed a massive acute right cerebellar infarction, but other modalities, including head and neck computed tomographic angiography (CTA) and magnetic resonance angiography (MRA), showed no obvious abnormalities. High-resolution vessel wall MRI (HR-VW-MRI) revealed right PICAD. The patient was diagnosed with massive cerebellar infarction caused by PICAD and active conservative treatment was initiated. The initial PICAD lesion disappeared 1.5 months after discharge, after which the patient experienced only slight weakness in his right limb for three months.

Since MRA and CTA may fail to identify PICAD, HR-VW-MRI is key in diagnosis and follow-up evaluation. Aggressive medication may be effective and safe for treating PICAD.