1).Īcute PICA infarct (arrow) involving the medial part of the posterior lobe of the cerebellum as well as the adjacent posterolateral medulla, as seen on DWI ( a) in a patient with lateral medullary or Wallenberg syndrome. A lateral medullary syndrome or Wallenberg syndrome may be seen with posterior inferior cerebellar artery (PICA) infarctions (Fig. Neurological signs associated with cerebellar infarcts include dysmetria, dysarthria, ataxia and nystagmus. It may mimic benign conditions such as viral gastroenteritis or labyrinthitis, which are often seen in patients admitted to the emergency department. Clinical PresentationĬerebellar infarcts typically present with non-specific symptoms such as dizziness, nausea, vomiting, unsteady gait and headache. We then review and illustrate the cerebellar arterial perfusion territories and the appearance of cerebellar infarcts as presented by MRI.
Pica infarct update#
In this article, we briefly review the clinical presentation of cerebellar infarctions, followed by a short review of cerebellar anatomy and an update on cerebellar infarct pathophysiology. Prompt diagnosis of cerebellar infarctions with the aid of MRI is thus warranted to prevent future stroke. Although patients diagnosed with cerebellar infarction on imaging often lack a clinical history of vertebrobasilar transient ischaemic attack (TIA) or stroke, they carry an increased risk of recurrent ischaemic events. This way, recent studies have indicated that most cerebellar infarcts initially remain unnoticed, and are only detected later on as an incidental infarct cavity on CT or MRI. In the cerebellum, however, FLAIR images are less robust due to magnetic field heterogeneities in the posterior fossa, while non-focal clinical symptoms and delays in MRI often lead to imaging outside the time frame of diffusion restriction. Subacute cerebellar infarcts may be missed on imaging due to a phenomenon called “fogging.”Ĭerebral infarcts on MRI are no longer a diagnostic challenge, mainly thanks to the strength of diffusion-weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) imaging. Small infarcts typically affect the cortex and often present as incidental cavities. Anterior inferior cerebellar artery-infarcts can be mistaken for lateral PICA-infarcts. The PICA supplies at least the medial part of the posterior cerebellar surface. The posterior inferior cerebellar artery (PICA)-territories can be visualised with super-selective territorial ASL MRI. Key Messages: MRI is the modality of choice for diagnosing cerebellar infarction. Similar to large cerebellar infarcts, recent studies investigating volumetric MRI datasets have now shown that small cerebellar infarcts occur in typical spatial patterns, knowledge of which may help in the diagnosis of even the smallest of cerebellar infarcts on MRI. Then, we review the arterial cerebellar perfusion territories recently made visible with territorial arterial spin labeling (ASL), followed by a discussion and illustration of the MRI appearance of cerebellar infarcts in different stages. Summary: We first briefly review the clinical presentation of cerebellar infarctions, followed by a short refresher on cerebellar anatomy and pathophysiological mechanisms of cerebellar infarcts. With adequate recognition of cerebellar infarction on MRI and prompt initiation or optimisation of preventive therapeutic measures, more dramatic strokes may be avoided in selected cases. Because of few or atypical clinical symptoms and a relatively low sensitivity of CT scans, many cerebellar infarctions may be detected only with MRI. Background: MRI is the imaging modality of choice for diagnosing brain infarction.