Vertebral artery occlusion mediated cerebellar and spinal cord infarction: A case report

This case report describes a rare instance of concurrent acute cerebellar and spinal cord infarction caused by right vertebral artery occlusion, providing dynamic angiographic visualization of the collateral circulation.

A 69-year-old male with hypertension and diabetes presented with thunderclap occipital headaches, left-dominant limb hypesthesia, and mild bladder dysfunction.

Brain magnetic resonance imaging revealed an acute right cerebellar infarction in the posterior inferior cerebellar artery (PICA) territory. Cervical magnetic resonance imaging demonstrated bilateral anterior horn hyperintensity ("owl's eye" sign) at C2 to C4, consistent with spinal cord infarction. Digital subtraction angiography confirmed atherosclerotic occlusion at the right vertebral artery origin, with collateral circulation via the deep cervical artery. Cerebrospinal fluid analysis showed elevated protein (0.679 g/L) without pleocytosis or autoantibodies (AQP4/MOG/MBP), excluding inflammatory/demyelinating etiologies.

The patient was treated with antiplatelet therapy (aspirin) and statins (rosuvastatin).

The patient's symptoms significantly improved within 2 weeks (headache Visual Analog Scale score decreased from 8 to 2).

This is the first reported case combining acute cerebellar (PICA territory) and cervical spinal cord (C2-C4) infarction, with digital subtraction angiography visualization of collateral circulation via the deep cervical artery. It underscores vertebral artery occlusion as a rare yet critical cause of dual cerebellar-spinal infarction, mediated by hemodynamic compromise in both PICA and anterior spinal artery territories.