BILATERAL SIMULTANEOUS CEREBELLAR INFARCTION IN THE MEDIAL BRANCHES OF THE POSTERIOR INFERIOR CEREBELLAR ARTERY TERRITORIES

We present an unusual case of simultaneous bilateral cerebellar infarc tion in the territory of the medial and intermediate branches of the p osterior inferior cerebellar arteries (mPICA). The patient, a 57-yr ol d woman, had no risk factors for cerebrovascular disease but a long-st anding hypertension. Pathogenetic hypotheses of this unusual ischemic site of lesion may be referred to: A) two PICAs arising from an occlud ed basilar artery; B) both medial branches arising from the same PICA on one side; C) a haemodynamic mechanism with hypoperfusion in the mos t peripheral branches of the arteries; D) a double, simultaneous embol ic stroke in mPICAs territory. Based on clinical course, supraortic du plex-scan, echocardiography, MRI, angioMRI and CT scans, and digital s ubtraction angiography, none of these hypotheses could be clearly asso ciated with the pathogenesis of the lesion. Nevertheless, we propose t hat an anomalous common mPICA for both cerebellar territories should r epresent the necessary condition for the ischemic insult and, simultan eously other factors should intervene as possible determining events.