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Infarctions of the brainstem and cerebellum: a correlation of computed tomography and angiography
Insights
Brainstem and cerebellum infarctions are common, often missed by CT scans due to artifacts. Most patients with posterior fossa mass effect and hydrocephalus recovered with medical management, not surgery.
Area of Science:
- Neurology
- Radiology
- Vascular Neurology
Background:
- Brainstem and cerebellum infarctions present diagnostic challenges.
- Computed tomography (CT) may miss inferiorly located infarcts due to artifacts.
- Posterior fossa mass effect and hydrocephalus are potential complications.
Purpose of the Study:
- To evaluate the frequency and location of brainstem and cerebellum infarctions.
- To assess the correlation between CT findings and angiography.
- To determine the outcomes of posterior fossa mass effect and hydrocephalus.
Main Methods:
- Retrospective review of 49 patients with CT and clinical evidence of brainstem/cerebellum infarction.
- Correlative angiography in 17 patients to identify vertebrobasilar system lesions.
- Analysis of CT findings, including localization and associated complications like mass effect and hydrocephalus.
Main Results:
- Forty-nine patients diagnosed with brainstem and cerebellum infarctions.
- Fifteen of 17 patients with angiography showed severe vertebrobasilar occlusive lesions.
- Poor correlation between CT and angiographic localization; inferior infarcts often missed by CT.
- Combined brainstem and cerebellum infarctions were frequent.
- Nineteen patients developed posterior fossa mass effect; eight developed hydrocephalus.
Conclusions:
- Combined brainstem and cerebellum infarctions are common.
- CT imaging limitations exist for detecting inferiorly located infarcts.
- Medical management of posterior fossa mass effect and hydrocephalus can lead to good recovery.
- Immediate surgical decompression may not be necessary for all cases.
Abstract:
Forty-nine patients were found to have computed tomographic (CT) and clinical evidence for infarction in the brainstem and cerebellum. Seventeen had correlative angiography, of which 15 had a severe occlusive vascular lesion somewhere in the vertebrobasilar system. The correlation between angiographic and CT localization of the infarcts was not good. Inferiorly located infarcts were probably often missed on CT because of basal artifacts. Combined infarctions of the brainstem and cerebellum were common. Nineteen of the 49 patients had an associated mass effect in the posterior fossa; in eight of these, hydrocephalus developed. Although immediate surgical decompression of the posterior fossa has been recommended for treatment of this complication, most of these patients recovered well with careful medical decompression.