Presentation
Acute onset of truncal ataxia and vertigo.
Patient Data
There is a linear focus of restricted diffusion on DWI/ADC within the right inferior cerebellar vermis. Features are consistent with a small, acute posterior-inferior cerebellar arterial (PICA) territorial infarct with associated increased signal intensity on T2 FLAIR imaging which is consistent with a duration of infarction of greater than 4 to 6 hours. SWI is negative – no hemorrhagic conversion.
There are scattered periventricular high signal intensity foci on T2 and T2 FLAIR imaging consistent with mild non-specific microvascular ischemic change. Time of flight intracranial MRA appears normal with no arteriovenous malformation and no acute stenosis or filling defect appreciated.
The remainder of the study is normal. Artifact within the left infratemporal fossa. left temporal lobe and left orbit, likely due to dental prosthesis.
Case Discussion
On a cursory and rapid review, one can easily miss the tiny acute infarct within the inferior cerebellar vermis as in this instance. The patient was remarkably well until the acute onset of vertigo and truncal ataxia, which was a dramatic and new clinical presentation and hence the need for an urgent MRI examination.
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