Superior cerebellar artery infarct

Last revised by Sonam Vadera on 15 Nov 2020

Superior cerebellar artery infarcts affect the superior cerebellar hemispheres, cerebellar vermis, and parts of the midbrain. The superior cerebellar artery is the most constantly identified vessel arising from the basilar artery with its origin just below the posterior cerebral artery in the distal segment.

Cerebellar infarcts comprise ~2% of all acute brain infarcts. Up to half of these involve the region of the superior cerebellar artery 1.

Cerebellar infarction often presents with non-specific symptoms such as nausea/vomiting, headache, and dizziness making initial diagnosis challenging. Superior cerebellar artery infarction can present in two distinct patterns depending on the site of occlusion 3, 4: 

  1. occlusion at the origin of the artery produces the classic presentation of ipsilateral cerebellar (ataxia, dysarthria, nystagmus) and brainstem (Horner’s syndrome) signs associated with a contralateral dissociated sensory impairment. Interestingly this was described initially by Mills over 100 years ago 5.
  2. peripheral occlusion presents with solely ipsilateral cerebellar signs.

Pseudotumoral cerebellar infarction, which can be seen in posterior inferior cerebellar artery infarction, has not been described for superior cerebellar artery infarcts.

Important causes of cerebellar infarction include atherosclerosis, cardiogenic emboli, and vertebral/basilar artery dissections 2. Proximal occlusions of the superior cerebellar arteries are often due to dissection or thrombosis, with peripheral occlusion typically due to embolization 3,4.

The imaging features are those of ischemic stroke in the vascular territory of the superior cerebellar artery: superior vermis, superior surface of the cerebellar hemispheres, much of the cerebellar white matter, and regions of the midbrain. 

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