Clinical Characteristics of Cerebellar Infarction Due to Arterial Dissection

Abstract

Objectives and background: Arterial dissection (AD) of the vertebral artery (VA) or its branches may cause ischemic stroke of the posterior circulation. However, clinical and radiological characteristics of patients with AD-related cerebellar infarction (CI) have rarely been reported.

Methods: Forty-nine patients with CI admitted to our department from April 2008 to March 2015 were identified from our database. After dichotomization into the AD and non-AD group, their demographics and presenting symptoms were compared. Subsequently, a multivariate regression analysis was performed to identify variables that correlated with AD.

Results: During the 7-year period, 14 and 35 patients were identified in the AD and non-AD group, respectively. The AD group was significantly younger than the non-AD group (55.0 ± 16.3 vs. 69.7 ± 10.7 years, P = 0.001) and was also more likely to experience acute pain at onset (86% vs. 17%, P < 0.001). Using a multivariate regression analysis, these two variables and the male sex were found to correlate with AD. AD was located in extracranial VA (n = 3); intracranial VA (n = 8); posterior inferior cerebellar artery (PICA) (n = 3); and superior cerebellar artery (n = 1). Identification of AD was delayed in one patient with an extracranial VA and one patient with a PICA dissection.

Conclusions: AD was responsible for approximately 30% of CI in our cohort. Pain at onset may be a useful symptom to identify patients with AD-related CI. While intracranial VA was the most common location of AD, physicians should be aware of the possibility of extracranial VA or PICA dissection in patients with seemingly unremarkable radiological findings.

Keywords: Arterial dissection; cerebellar infarction; extracranial; posterior inferior cerebellar artery; vertebral artery.

Figure 1

A brain computed tomography of a 54-year-old man presenting with left-sided hemianopsia revealed a subcortical hemorrhage (a). A diffusion-weighted magnetic resonance imaging showed an area of a high-intensity signal in the left cerebellar hemisphere (b). The left posterior inferior cerebellar artery was not depicted on the brain magnetic resonance angiography (c). Computed tomography angiography of the neck showed a tapered occlusion of the left vertebral artery inside the transverse foramen (d, white arrowheads). A contrast-enhanced axial image at the C5 level showed a double-lumen sign (e, black arrow)

Figure 2

A diffusion-weighted magnetic resonance image revealed an area containing a high-intensity signal in the left cerebellar hemisphere (a) The depiction of the right posterior inferior cerebellar artery was poor on the brain magnetic resonance angiography (b). Computed tomography angiography revealed a pearl-string lesion at the orifice of the right posterior inferior cerebellar artery (c, black circle). A repeat computed tomography angiography showed improvement in the stenosis of the posterior inferior cerebellar artery distal to the dissection (d, black circle)