Tiny infarction of rostral cerebellum manifested by contralesional body lateropulsion

TL;DR

A small stroke in the rostral cerebellum caused unexpected contralesional body lateropulsion, suggesting involvement of vestibular pathways.

Contribution

Reports a novel case of contralesional body lateropulsion caused by a rostral cerebellar infarction, challenging typical localization patterns.

Findings

A left anterior paravermal infarction caused contralesional body lateropulsion.

Damage to vestibular pathways via the superior cerebellar peduncle may explain the symptoms.

Complete recovery of body lateropulsion occurred after the infarction.

Abstract

Body lateropulsion (BLP) has been reported several times after cerebellar infarction. It is usually ipsilateral to the cerebellar infarction, particularly when limited to the rostral cerebellum. In contrast, contralesional BLP after cerebellar infarction has been reported in more caudal regions of the cerebellum (such as the nodulus or the tonsil).

We report the case of a small infarction of the left anterior paravermis of the rostral cerebellum which resulted in bilateral symptoms: ipsilesional limb ataxia and, unexpectedly, contralesional BLP.

Several neurological pathways were potentially involved. Both right and left dorsal spinocerebellar tracts may have been damaged by the infarction of the left anterior paravermis. On the other hand, the proximity of the infarct to the superior cerebellar peduncle may have caused damage to the vestibular pathways (fastigio-vestibular or dentato-vestibular tracts), as they exit the cerebellum by the superior cerebellar peduncle. A lesion of the cerebellum close to the superior cerebellar peduncle could result in a contralesional BLP.

•Lesion in rostral cerebellum responsible of contralesional body lateropulsion.•Vestibular pathways could be damaged by paravermal infarction.•Early and complete recovery of body lateropulsion after paravermal infarction.

Lesion in rostral cerebellum responsible of contralesional body lateropulsion.

Vestibular pathways could be damaged by paravermal infarction.

Early and complete recovery of body lateropulsion after paravermal infarction.

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