Indian Journal of Medical Specialities

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 12  |  Issue : 2  |  Page : 102-

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

Correspondence Address:
Dr. Abhishek Juneja
Maharaja Agrasen Hospital, New Delhi - 110 026
India




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


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 May 28 ];12:102-102
Available from: http://www.ijms.in/text.asp?2021/12/2/102/312618


Full Text



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}

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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References

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3Kataoka H, Izumi T, Kinoshita S, Kawahara M, Sugie K, Ueno S. Infarction limited to both middle cerebellar peduncles. J Neuroimaging 2011;21:e171-2.
4Akiyama 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.