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Cerebellar hemorrhagic infarction
C J Chaves1, M S Pessin, L R Caplan
1Department of Neurology, New England Medical Center, Boston, MA 02111, USA.
Insights
Hemorrhagic cerebellar infarcts, often involving major arteries, typically present without initial bleeding signs. Most patients remain stable or improve, even when on anticoagulation.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroradiology
Background:
- Cerebellar hemorrhagic infarcts are uncommon but can lead to significant neurological deficits.
- Understanding their vascular origins, stroke mechanisms, and clinical progression is crucial for patient management.
Purpose of the Study:
- To investigate the vascular anatomy, stroke mechanisms, and clinical course of patients with cerebellar hemorrhagic infarcts.
- To compare the characteristics of posterior circulation hemorrhagic infarcts with those in the anterior circulation.
Main Methods:
- Retrospective analysis of 17 patients with 26 cerebellar hemorrhagic infarcts.
- Review of vascular territories (superior cerebellar artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery), imaging findings, and clinical data.
- Assessment of stroke mechanisms and management, including anticoagulation status.
Main Results:
- Sixteen infarcts involved the superior cerebellar artery territory, nine the posterior inferior cerebellar artery, and one the anterior inferior cerebellar artery.
- Infarcts frequently involved the full territory of the supplying artery (73%).
- Hemorrhagic transformation was detected on serial scans within 15 days, often not apparent on initial imaging. Most patients were stable or improving, and anticoagulation was generally well-tolerated.
Conclusions:
- Cerebellar hemorrhagic infarcts often stem from embolic events and share similarities in causes, imaging, and consequences with anterior circulation infarcts.
- Early detection via serial imaging is important, and anticoagulation may be safely continued in select cases.
- These findings aid in understanding and managing posterior circulation strokes.
Abstract:
We investigated 17 patients with 26 cerebellar hemorrhagic infarcts for their vascular anatomy, stroke mechanisms, and clinical course. Sixteen infarcts involved the superior cerebellar artery, nine the posterior inferior cerebellar artery, and one the anterior inferior cerebellar artery territories. The infarcts involved the full territory of the supplying arteries in 19 of 26 infarcts (73%). Sixteen of 17 patients were stable or improving when the hemorrhagic infarction was detected. All but one patient had an imaging study at the time of presentation that was negative for blood; hemorrhagic infarction was detected on routine serial scans performed during the first 15 days. Nine of the 17 patients were on anticoagulants when the cerebellar hemorrhagic infarct was detected; anticoagulation was maintained in eight of them with no clinical worsening. The stroke mechanism in all patients was considered embolic from cardiac and intra-arterial sources. The causes, imaging findings, and consequences of hemorrhagic infarcts in the posterior circulation are similar to those in the anterior circulation.