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| LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 12
| Issue : 2 | Page : 102 |
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Bilateral middle cerebellar peduncle infarction
Abhishek Juneja1, Kuljeet Singh Anand2, Himank Goyal1
1 Department of Neurology, Maharaja Agrasen Hospital, New Delhi, India
2 Department of Neurology, Dr. RML Hospital, New Delhi, India
| Date of Submission | 07-Jan-2021 |
| Date of Decision | 10-Jan-2021 |
| Date of Acceptance | 13-Jan-2021 |
| Date of Web Publication | 30-Mar-2021 |
Correspondence Address:
Dr. Abhishek Juneja
Maharaja Agrasen Hospital, New Delhi - 110 026
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/injms.injms_1_21
How to cite this article:
Juneja A, Anand KS, Goyal H. Bilateral middle cerebellar peduncle infarction. Indian J Med Spec 2021;12:102 |
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
Click here to view |
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.
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | 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.  |
| 2. | 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. |
| 3. | 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. |
| 4. | 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. |
[Figure 1]
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