Ischaemic cerebellar infarct with early haemorrhagic transformation

Case contributed by Dr Craig Hacking


Sudden onset right leg weakness, ataxia and vertigo. AF on aspirin.

Patient Data

Age: 65-70 years
Gender: Male

Stroke MRI - DWI/ADC only

There is an area of restricted diffusion consistent with acute infarction within the right cerebellum and right occipital lobe. The right cerebellar infarct demonstrates peripheral restricted diffusion with without restriction in he central infarct suggesting interval haemorrhage. Non-contrast CT is recommended for confirmation.


Progressive hypodensity in the right cerebellar hemisphere and right occipital lobe is in keeping with acute infarction. Parenchymal haemorrhage measuring has developed in the superior right cerebellar hemisphere within the infarct since the initial CT. Mass effect in the posterior fossa causes minor leftward midline shift and partial effacement of the fourth ventricle. No hydrocephalus or herniation.

The tip of the basilar artery appears hyperdense on thick slices (less conspicuous on thin slices), unchanged in appearance compared to the previous CT (at which time the basilar artery was patent on CTA).

Case Discussion

An example of the evolution of an infarct occurring in front of our eyes.

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Case information

rID: 34682
Case created: 5th Mar 2015
Last edited: 18th Aug 2017
Inclusion in quiz mode: Included

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