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Unusual pattern of bilateral cerebellar infarct and bihemispheric posterior-inferior cerebellar artery
  1. Monique Boukobza1,
  2. Jean-Pierre Laissy1,2
  1. 1 Department of Radiology—BICHAT Hospital, Assistance Publique—Hopitaux de Paris, Paris, France
  2. 2 INSERM U1148, Paris, France
  1. Correspondence to Dr Monique Boukobza, Radiology - BICHAT Hospital, Assistance Publique Hopitaux de Paris, 75018 Paris, France, France; m.boukobza{at}

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A 55-year-old man, without medical history, was admitted for acute onset of headache, vertigo, nausea and unsteady gait. Neurological examination demonstrated gait and limb ataxia, lingual dysarthria, leftward horizontal nystagmus, temperature sensory deficits of the right hemiface and contralateral extremities, consistent with a lateral medullary syndrome.

Diffusion-weighted imaging showed acute bilateral cerebellar infarcts in the PICA territory, sparing the medial areas of both cerebellar hemispheres and extending to the right lateral medulla oblongata and the right cerebellar tonsil, the right ventral part of the inferior cerebellar vermis, and the surface of the right biventral lobule of the cerebellum (figure 1A,B).

Figure 1

Bilateral cerebellar infarct and bilateral posterior-inferior cerebellar artery (Bi-PICA). (A and B) Diffusion-weighted images show acute ischaemia in the right true Bi-PICA territory—which arises beyond the right vertebral artery occlusion—involving the right cerebellar hemisphere except its medial part, the posterior-lateral right medulla and partially the left cerebellar hemisphere (A, vignette, red area). The acute ischaemia spares the medial areas of both cerebellar hemispheres (A, vignette, blue area). (C and …

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  • Contributors All authors of this work made substantial contributions to the conception and design, acquisition of the data, analysis and interpretation of the data, and drafting, critically revising and final approval of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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