The authors report 12 patients with acute bilateral cerebellar infarcts in
posterior inferior cerebellar artery (PICA) territory. They found three top
ographic patterns: A) bilateral medial PICA in six patients; B) unilateral
whole + contralateral medial PICA in four; and C) bilateral small multiple
in two. Nine patients in Groups A and B had unilateral PICA or vertebral ar
tery disease, and both patients in Group C had bilateral vertebral artery d
isease. These findings support that unilateral supply to both medial PICA t
erritories may be the most relevant pathogenesis of this syndrome.