Yonsei Med J.  2013 Nov;54(6):1538-1541. 10.3349/ymj.2013.54.6.1538.

A Case of Cerebellar Infarction Caused by Acute Subclavian Thrombus Following Minor Trauma

• Park H
• Kim HJ
• Cha MJ
• Lee JY
• Koh IS
• Nam HS

• KMID: 1798155
• DOI: http://doi.org/10.3349/ymj.2013.54.6.1538

Abstract

Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.

Keyword

Subclavian steal syndrome; brain infarction; thrombosis

MeSH Terms

Brain Infarction/*diagnosis/etiology/pathology
Cerebellar Diseases/diagnosis/etiology
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Thrombosis/*complications

Figure

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  Fig. 1 (A) The left hand of the patient was pale and cold. (B) Acute infarctions in the left cerebellar hemisphere and vermis are shown in diffusion-weighted MRI.

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  Fig. 2 (A) Initial Doppler ultrasonography of the left vertebral artery shows bidirectional wave. (B) A provocative hyperemic cuff test on the left arm aggravates flow reversal, which is compatible with a partial subclavian steal syndrome. (C) After anticoagulation, follow-up Doppler ultrasonography shows that a systolic deceleration is still seen, but there is no retrograde flow. (D) No augmented flow reversal is noted in the hyperemic cuff test, which is compatible with a pre-steal phenomenon.

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  Fig. 3 (A) Digital subtraction angiography shows a large thrombus in the proximal left subclavian artery. (B) Ten days after admission, a follow-up study shows markedly decreased thrombus size.

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