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Infratentorial infarction: correlation of MR findings with neurological and angiographical features
1Department of Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan.
Abstract:
Using magnetic resonance imaging, we reviewed 141 infratentorial infarcts in 81 consecutive cases: 65 infarcts were seen in the paramedian pons, while 18 in the posterior inferior cerebellar artery (PICA) territory and 17 in the watershed area between PICA and superior cerebellar artery. No comparable sign or symptom was observed for 44 (31.2%) infarcts, whereas 66 (46.8%) infarcts appeared symptomatic and 31 (22.0%) infarcts were regarded as equivocal mainly due to the coexisting supratentorial lesions or non-localizing symptoms. The frequent coexistence of basal ganglionic small infarcts in those with infratentorial small (< 15 mm) infarcts implicated their common pathogenetic background. The fact that atrial fibrillation was seen in 33.3% of those with large (> 15 mm) infarcts whereas it was seen in only 6.5% of those with small infarcts may suggest a cardiogenic embolism as a possible cause of infratentorial large infarcts. Major artery occlusive lesion was seen in 15 of 22 cases with cerebellar infarction, whereas no occlusive lesion was seen in the majority of cases with pontine small infarcts. With MR imaging, infratentorial infarcts were detected more frequently than in the previous studies based on X-ray CT, and they can be considered as a benign condition.
Insights
Magnetic resonance imaging (MRI) identified 141 infratentorial infarcts. Large infarcts may stem from cardiogenic embolism, while small infarcts share a common pathogenetic background with basal ganglia lesions.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Infratentorial infarcts are challenging to detect and diagnose.
- Previous studies relied on X-ray CT, potentially underestimating prevalence.
- Understanding the etiology and characteristics of infratentorial infarcts is crucial for patient management.
Purpose of the Study:
- To characterize infratentorial infarcts using magnetic resonance imaging (MRI).
- To investigate the potential causes and associations of these infarcts.
- To compare MRI findings with previous CT-based studies.
Main Methods:
- Retrospective review of 141 infratentorial infarcts in 81 patients using MRI.
- Analysis of infarct location (paramedian pons, PICA territory, watershed areas).
- Correlation of infarcts with clinical symptoms, comorbidities (atrial fibrillation), and arterial lesions.
Main Results:
- MRI detected 141 infratentorial infarcts, more frequently than prior CT studies.
- Symptomatic infarcts were observed in 46.8%, with 22.0% being equivocal.
- Large infarcts (>15 mm) showed a higher association with atrial fibrillation (33.3%), suggesting cardiogenic embolism.
- Small infarcts (<15 mm) frequently coexisted with basal ganglia infarcts, indicating a shared pathogenetic background.
- Cerebellar infarcts were often associated with major artery occlusive lesions (15/22 cases).
Conclusions:
- MRI is a sensitive tool for detecting infratentorial infarcts.
- Infratentorial infarcts have diverse etiologies, including cardiogenic embolism and atherosclerotic disease.
- Small infratentorial infarcts may share etiological factors with small vessel disease in other brain regions.
- Despite their location, infratentorial infarcts detected by MRI may represent a benign condition in some cases.