J Korean Neurosurg Soc.  2013 Sep;54(3):239-242. 10.3340/jkns.2013.54.3.239.

Bilateral Superior Cerebellar Artery Infarction after Stent-Angioplasty for Internal Carotid Artery Stenosis

• Kim JH
• Lee JH
• Jo KD
• You SH

• KMID: 2190905
• DOI: http://doi.org/10.3340/jkns.2013.54.3.239

Abstract

Spontaneous bilateral cerebellar infarction in the territory of the superior cerebellar arteries is extremely rare. Occasionally there have been reports of bilateral cerebellar infarction due to vertebrobasilar atherosclerotic occlusion or stenosis, whereas no report of bilateral cerebellar infarction due to complicated hemodynamic changes. In this report, we present a patient with bilateral cerebral infarctions related to stenoses of bilateral internal carotid arteries, in whom vertebrobasilar system was supplied by multiple collaterals from both posterior communicating arteries and right external carotid artery. We performed stent-angioplasty of bilateral internal cerebral arterial stenosis, and then acute infarction developed on bilateral superior cerebellar artery territories. The authors assumed that the infarction occurred due to hemodynamic change between internal carotid artery and external carotid artery after stent-angioplasty for stenosis of right internal carotid artery.

Keyword

Bilateral cerebellar infarct; Stent-angioplasty; Hemodynamic change

MeSH Terms

Arteries*
Carotid Artery, External
Carotid Artery, Internal*
Carotid Stenosis*
Cerebral Infarction
Constriction, Pathologic
Hemodynamics
Humans
Infarction*

Figure

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  Fig. 1 Diffusion weighted-magnetic resonance imaging at admission, showing bilateral anterior cerebral artery-middle cerebral artery borderzone infarction.

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  Fig. 2 Magnetic resonance angiogram, showing high grade stenoses of both proximal internal cerebral arteries.

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  Fig. 3 Left common carotid angiogram (A), showing 85% stenosis of the left proximal internal cerebral artery (ICA). Right common carotid angiogram (B), showing 90% stenosis of the right proximal ICA, and right occipital artery from right external cerebral artery supplying right vertebral artery and then basilar artery to basilar tip.

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  Fig. 4 Left subclavian angiogram, showing multifocal stenosis of the left vertebral artery with faint flow to basilar artery.

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  Fig. 5 Left internal cerebral artery angiograms (ICA) (A) and right ICA angiogram (B), showing well visualized posterior communicating arteries to posterior cerebral arteries, but no retrograde filling to basilar artery.

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  Fig. 6 Post stent-angioplasty angiogram for left internal cerebral artery (ICA) stenosis (A), and right ICA stenosis (B), showing fully dilated both ICA stenoses.

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  Fig. 7 Diffusion weighted-magnetic resonance imaging at 2 days after stent-angioplasty for right proximal internal cerebral artery stenosis, showing acute cerebellar infarction in the territory of both superior cerebellar arteries.

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