Bilateral cerebellar infarction due to embolization of the bihemispheric posterior inferior cerebellar artery

Abstract

A 77-year-old woman complaining of dizziness was taken to a local hospital by ambulance. Magnetic resonance imaging (MRI) of her head revealed a bilateral cerebellar infarction, and she was admitted. The next morning, she became drowsy, and head CT revealed obstructive hydrocephalus. She was transferred to our hospital, where we immediately performed posterior fossa decompression. After the surgery, her consciousness improved and she returned to the first hospital for rehabilitation. This is a case of a bilateral cerebellar embolic infarction caused by atrial fibrillation. Head MRI revealed a bihemispheric posterior inferior cerebellar artery (PICA), which ran along the midline and bilaterally separated into the cerebellar hemispheres after branching off from the extracranial vertebral artery. There are few previous reports on ischemic stroke patients with a bihemispheric PICA, as it is a rare anomaly. It carries an increased risk of bilateral cerebellar infarctions that may progress to obstructive hydrocephalus. It is important to pay particular attention to patients with cerebellar vascular disease who display this anomaly.