Bilateral Cerebellar Infarction Caused by Occlusion of a Bihemispheric Posterior Inferior Cerebellar Artery Variant: A Case Report

TL;DR

A rare case of bilateral cerebellar infarction caused by a unique blood vessel variant highlights the importance of recognizing unusual vascular structures in stroke management.

Contribution

This case report highlights a rare bihemispheric PICA variant causing bilateral infarction and obstructive hydrocephalus.

Findings

An 81-year-old male presented with bilateral cerebellar infarction and obstructive hydrocephalus.

A bihemispheric PICA variant was identified as the cause of the infarction.

Early recognition of vascular anomalies is critical for stroke management.

Abstract

Bilateral cerebellar infarction due to unilateral occlusion of the posterior inferior cerebellar artery (PICA) is extremely rare, particularly when a bihemispheric PICA variant is present. We report the case of an 81-year-old male with a history of hypertension and diabetes who presented with recurrent vomiting and gait disturbance, eventually progressing to a comatose state. MRI revealed bilateral cerebellar infarctions sparing the brainstem and ventricular enlargement consistent with obstructive hydrocephalus. Magnetic resonance angiography (MRA) demonstrated occlusion of the right PICA, while an earlier MRA had identified a bihemispheric PICA variant originating from the right vertebral artery and supplying both cerebellar hemispheres. Echocardiography did not reveal any embolic source. This case underscores the clinical importance of early recognition of rare vascular anomalies, such as the bihemispheric PICA variant, which is critical for optimal stroke management and the prevention of complications like obstructive hydrocephalus.

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