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Table of Contents
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 102

Bilateral middle cerebellar peduncle infarction

1 Department of Neurology, Maharaja Agrasen Hospital, New Delhi, India
2 Department of Neurology, Dr. RML Hospital, New Delhi, India

Date of Submission07-Jan-2021
Date of Decision10-Jan-2021
Date of Acceptance13-Jan-2021
Date of Web Publication30-Mar-2021

Correspondence Address:
Dr. Abhishek Juneja
Maharaja Agrasen Hospital, New Delhi - 110 026
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_1_21

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How to cite this article:
Juneja A, Anand KS, Goyal H. Bilateral middle cerebellar peduncle infarction. Indian J Med Spec 2021;12:102

How to cite this URL:
Juneja A, Anand KS, Goyal H. Bilateral middle cerebellar peduncle infarction. Indian J Med Spec [serial online] 2021 [cited 2022 Aug 15];12:102. Available from: http://www.ijms.in/text.asp?2021/12/2/102/312618

Dear Editor,

A 65-year-old male presented with complaints of retrosternal chest pain and diaphoresis. The patient was diagnosed as a case of coronary artery disease with acute myocardial infarction. He had hypertension for the past 15 years on irregular treatment. The patient underwent coronary artery bypass grafting, during which he developed hypotension. The patient was managed with vasopressor agents and shifted to postoperative unit. Later, the patient complained of vertigo and vomiting after regaining consciousness. Neurological examination revealed incoordination and gait ataxia. Routine blood investigations including blood counts, glycemic, hepatic, and renal profile were within normal limits. Magnetic resonance (MR) imaging of brain revealed bilateral middle cerebellar peduncle (MCP) infarcts [Figure 1]. MR angiogram of head-and-neck vessels showed diffuse vertebral artery atherosclerotic disease. The patient was managed with antiplatelet medication and discharged later in stable condition.
Figure 1: Imaging of brain showing diffusion restriction in bilateral middle cerebellar peduncles

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Middle cerebellar peduncle infarction in isolation is a rare occurrence, seen in roughly 0.12% of acute strokes.[1] There have been only a few case reports of isolated bilateral MCP infarction in literature.[2],[3] MCP is a watershed zone between two arteries, namely, anterior inferior cerebellar artery and superior cerebellar artery.[4] Our patient developed bilateral isolated MCP infarcts following hypotensive episode during coronary artery bypass grafting with underlying diffuse atherosclerotic vertebral artery insufficiency.

Bilateral isolated MCP infarcts are a rare stroke presentation, following cerebral hypoperfusion. Our case is supportive of the fact that it is watershed zone, may undergo infarction in hypotensive states specially with underlying compromised posterior brain circulation.

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There are no conflicts of interest.

  References Top

Roquer J, Lorenzo JL, Pou A. The anterior inferior cerebellar artery infarcts: A clinical-magnetic resonance imaging study. Acta Neurol Scand 1998;97:225-30.  Back to cited text no. 1
Amarenco P, Hauw JJ. Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. A clinicopathological study of 20 cases. Brain 1990;113 (Pt 1):139-55.  Back to cited text no. 2
Kataoka H, Izumi T, Kinoshita S, Kawahara M, Sugie K, Ueno S. Infarction limited to both middle cerebellar peduncles. J Neuroimaging 2011;21:e171-2.  Back to cited text no. 3
Akiyama K, Takizawa S, Tokuoka K, Ohnuki Y, Kobayashi N, Shinohara Y. Bilateral middle cerebellar peduncle infarction caused by traumatic vertebral artery dissection. Neurology 2001;56:693-4.  Back to cited text no. 4


  [Figure 1]


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