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Two distinct profiles emerged,depending on the vascular territory involved.In 36 patients with posterior inferior cerebellar artery territory infarcts,a triad of vertigo,headache,and gait imbalance predominated at stroke onset.Computed tomography showed severe cerebellar mass effect in 11 cases(30%),with associated hydrocephalus in seven.In these seven patients(19%),postinfarct swelling led to brain stem compression that resulted in four deaths.In 30 patients with superior cerebellar artery infarcts,gait disturbance predominated at onset;vertigo and headache were significantly less common.The clinical course was usually benign.Computed tomography showed marked cerebellar mass effect, hydrocephalus,and brain stem compression in only two instances(7%). Presumed cerebral embolism was the predominant stroke mechanism in patients with superior cerebellar artery distribution infarcts,whereas in those with posterior inferior cerebellar artery distribution infarcts,the stroke mechanism was equally divided between cardiogenic embolism and posterior circulation arterial disease.Cerebellar infarcts in the posterior inferior cerebellar artery and superior cerebellar artery distribution have distinct differences in clinical presentation,course,and prognosis.These differences should help in the selection of appropriate monitoring and treatment strategies. |
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