Cerebellar infarction seondary to non-atheroslcerotic vasculopathy of the vertebral artery
Presentation
Severe dizziness and vertigo.
Patient Data
Right cerebellar large acute infarction involves the inferior aspect and the vermis, eliciting low T1, high T2, high DWI and low ADC signals.
Significant mass effect on the 4th ventricle with early supratentorial hydrocephalic changes.
Abnormal signal of the right vertebral artery in T1, T2 and FLAIR compared to the normal signal-void left artery.
In the post-contrast T1, the right vertebral artery appears enlarged and shows internal enhancement compared to the non-enhanced signal-void left artery suggesting slow flow in the right artery. In addition, the right vertebral artery shows an intraluminal thin line extending to the origin of the basilar artery.
CT cerebral angiography
Diseased right vertebral artery along its extra-cranial and intra-cranial courses presents a beaded appearance with multiple variably stenotic segments with associated variable wall thickening which are marked at the artery origin from the right subclavian artery. Intraluminal densities are noted. The artery still shows enhancement along its course.
The basilar artery origin is likely involved.
The rest of the cerebral arteries are normal with no atherosclerotic changes.
Case Discussion
This is a case of cerebellar infarction secondary to vasculopathy of the vertebral artery that is mostly non-atherosclerotic considering the patient's age and negative atherosclerotic disease of the rest of the cerebral arteries.
The top DD include dissection, vasculitis, and FMD.
The patient was referred to another center for interventional catheter cerebral angiography and lost for follow-up.
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