Arterial pathology in cerebellar infarction.

Abstract

We reviewed 88 pathologically proven cerebellar infarcts, examining the entire thoracocervical arterial system (including the spinal part of the vertebral artery, the intracranial arteries, and the heart) in all cases. For 50 infarcts, we found an arterial occlusion. The intracranial part of the vertebral artery was involved in 38 infarcts (76%), the basilar artery in 20 infarcts (40%), and a cerebellar artery in 12 infarcts (24%). Eight infarcts were due to bilateral distal vertebral artery occlusions. For the 50 infarcts, the cause of the occlusion was atherosclerosis in 28 (56%) and a cardiac embolism in 12 (24%). For the remaining 38 infarcts, we found no arterial occlusions on postmortem examination. Of these 38 infarcts, 26 (68%) were associated with a cardiac source of emboli. For the entire group of 88 infarcts, atherosclerosis was the cause in 31 (35%), while a cardiac embolism was proven or presumed in 38 (43%). Dissecting aneurysms, atherosclerotic artery-to-artery embolism, or hemodynamic mechanisms could have been responsible for a few infarcts. We conclude that cerebellar infarcts often arise from cardiogenic embolism. (Stroke 1990;21:1299-1305)

Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use

“…Our cases involved large infarcts in regions of Ͼ1 cerebellar vessel, in contrast to the vast majority of cerebellar strokes, which are typically in the distribution of a single vessel. 16,17 The neuropharmacologic literature regarding THC generally describes neuroprotective effects from oxidant injury at least in tissue culture 18,19 as well as therapeutic effects including analgesia, ocular hypotension, and antiemesis. 18 In a rat model of focal cerebral ischemia, synthetic cannabinoid agonists have been reported to reduce infarct volume.…”

Long-Term Follow-Up of Patients after Intraarterial Thrombolytic Therapy of Acute Vertebrobasilar Artery Occlusion

“…Top-of-the-BA occlusions are mainly of embolic origin and, therefore, thrombolytic therapy is more effective than in occlusions representing the end point of a protracted artherosclerotic disease. In addition, the thrombolytic mass is smaller than with other types of occlusion [14, 15]. Moreover, the branches penetrating into the brain stem may stay occluded in patients with caudal, midbasilar and mixed-type occlusions even after adequate recanalization of the BA, the mechanisms being the same as those described in striatocapsular infarcts after middle cerebral artery occlusions and recanalization [16].…”

Intracranial Vertebral Artery Disease in the New England Medical Center Posterior Circulation Registry

“…Past reports link ICVA disease inextricably with in farction in the proximal posterior circulation territory which include the medulla [6][7][8][9] and the PICA cerebellum [10][11][12][13][14]21. 22], However, in our series of patients with ICVA disease, only one-fourth had infarcts limited to the proximal intracranial territory'.…”

“…In another necropsy study of 6 patients with fatal ICVA disease the location of the infarcts was mainly hemimedullary and lower pons [4], ICVA occlusion was the most common vascular lesion found in necropsy studies of patients with lateral medulla ry infarcts [6][7][8][9] and the portion of the cerebellum sup plied by the posterior inferior cerebellar arteries [10][11][12][13][14], A few clinical studies have been reported [15][16][17][18][19] but the numbers of patients were small, and the studies were ret rospective and anecdotal. Bilateral ICVA disease was dis cussed only in several retrospective studies [18,19].…”