Cerebellar Infarct

Cerebellar infarcts are acute ischemic stroke subtypes caused by the occlusion of 1 of the 3 main cerebellar branches of the vertebrobasilar arterial system or the posterior circulation, namely, the superior (SCA), anterior inferior (AICA), and posterior inferior (PICA) cerebellar arteries. Posterior circulation infarcts account for approximately 20% of all acute ischemic strokes. Cerebellar infarcts account for only 3% of all ischemic strokes in the United States. Despite their relatively low frequency, cerebellar strokes carry significant morbidity and mortality, attributed to the challenges arising from their occasionally subtle initial presentation and the adverse effects of reactive swelling in the posterior fossa. Cerebellar infarcts demand attention due to their unique diagnostic and management challenges.

Occlusion of 1 of the 3 named cerebellar arteries usually causes larger, symptomatic cortical and subcortical infarcts. However, the more widespread use of brain magnetic resonance imaging (MRI) has revealed many cases of small cerebellar infarcts, which are mainly cortical and may not correspond to cerebellar arterial territories. These small cerebellar infarcts, in isolation, may be completely asymptomatic, often detected as incidental MRI findings of ischemic cortical cavities.