The Cerebellar Arteries: Cortical Patterns and Vascularization of the Cerebellar Nuclei

Icardo, José M.; Ojeda, Jorge; García‐Porrero, Juan A.; Hurlé, Juan M.

doi:10.1159/000145545

Cited by 30 publications

(24 citation statements)

References 7 publications

(9 reference statements)

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“…Small perforating arteries branch off from the circumferential arteries to penetrate the cerebellum. Anastomoses between the circumferential arteries of PICA, AICA and SCA are constantly present among individuals [7,8]. …”

Section: Anatomymentioning

confidence: 99%

Very Small Cerebellar Infarcts: Integration of Recent Insights into a Functional Topographic Classification

et al. 2013

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Background: Very small cerebellar infarcts (diameter <2 cm) are a frequent finding on MRI. With an increasing scientific interest in cerebral microinfarcts, very small infarcts in the cerebellum deserve more of our attention as well. The goal of the present article was to review infarct terminology and mechanisms, as well as to critically appraise the current classification system for very small cerebellar infarcts. Methods: A search strategy was designed to identify all relevant studies on very small cerebellar infarcts in the English language. This search was restricted to papers published up to February 21, 2013. Studies were initially identified from the MEDLINE/PubMed database using the search terms ‘small cerebellar infarct', ‘lacunar infarct', ‘microinfarct', ‘end zone infarct', ‘border zone infarct', ‘watershed infarct', ‘territorial infarct', and ‘nonterritorial infarct'. Furthermore, a similar search strategy was directed to identify all relevant articles on (descriptive and functional) neuroanatomy and neuroimaging of the cerebellum. Results: Very small cerebellar infarcts have been referred to as lacunar infarcts, as junctional, border zone or watershed infarcts, as nonterritorial infarcts, as very small territorial or end zone infarcts, or simply as (very) small cerebellar infarcts. Since the original clinicoradiological study on these small infarcts, the classification into border zones remains in common use. This classification is based upon the assumption that these infarcts occur secondary to low flow in between arterial perfusion territories, where flow is believed to be the lowest. Later studies, however, have suggested occlusion of small (end-) arteries as a prerequisite for the pathogenesis of even small cerebellar infarcts, with low flow merely as a potential contributor. Therefore, it is likely that infarcts may as well occur in a nonborder zone distribution. Moreover, the classification into border zones may be considered unreliable since the location of border zones is highly variable among individuals and is not known in a particular patient. Recently, a functional topographic organization has been found in the cerebellum with evidence for a motor-nonmotor dichotomy between the anterior and posterior lobe. Since the cerebellar lobes can be easily and reliably distinguished with both CT and MRI, we recommend the classification of very small cerebellar infarcts according to topographic location. Conclusion: There are several fundamental concerns with the current classification of very small cerebellar infarcts according to border zones, which we would like to overcome by recommending a new classification system based on topography. This will allow for a reliable and reproducible way of classifying very small cerebellar infarcts and is expected to improve clinicoradiological correlation.

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Section: Anatomymentioning

confidence: 99%

Very Small Cerebellar Infarcts: Integration of Recent Insights into a Functional Topographic Classification

et al. 2013

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“…In the human, it has been indicated that nucleus lateralis cerebelli and the other nuclei are supplied by the rhomboidal artery, which is the innermost branch of the superior cerebellar artery (Icardo et al, 1982). However, the rhomboidal artery is not defined in the Nomina Anatomica Veterinaria (International Committee on Veterinary Gross Anatomical Nomenclature, 1994).…”

Section: Discussionmentioning

confidence: 99%

“…The rhomboidal artery arises from the inner side of the superior cerebellar artery and then, following the crus cerebelli rostralis, it enters the cerebellum and gives off 2-4 branches. It supplies blood mainly to the nucleus lateralis cerebelli and the other nuclei (Icardo et al, 1982).…”

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confidence: 99%

Vascularisation of the cerebellar nuclei in Akkaraman sheep

Dinçer

Gültiken

2003

Acta Veterinaria Hungarica

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This study reports an anatomical study of the vascular supply in 20 Akkaraman sheep cerebelli from adult subjects of both sexes. The origin and branching pattern of the cerebellar artery vascularising the cerebellar nuclei were studied by gross dissection and vascular injection. Then dissection was performed and vessels nourishing the cerebellar nuclei were documented. Four bilaterally symmetrical cerebellar nuclei were determined as nucleus lateralis cerebelli, nucleus interpositus lateralis cerebelli, and nucleus interpositus medialis cerebelli and nucleus fastigii from lateral to medial side. It has been previously confirmed that vascularisation of the cerebellar nuclei is carried out by intermediary branches of the rostral cerebellar artery and the caudal cerebellar artery. However, this study has confirmed that the caudal cerebellar artery has no contribution in the vascularisation of the cerebellar nuclei.

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“…Anastomoses between peripheral branches of the PICA, AICA, and SCA are consistently present among individuals [13,15,16]. The territory perfused by the AICA varies in reciprocity with the PICA and SCA [13,16]. It may be confined to the anterior surface, but the AICA may also supply lateral portions of the posterior and/or superior surface of the cerebellum (Fig.…”

Section: Anatomymentioning

confidence: 99%

MRI of Cerebellar Infarction

2017

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Background: MRI is the imaging modality of choice for diagnosing brain infarction. Because of few or atypical clinical symptoms and a relatively low sensitivity of CT scans, many cerebellar infarctions may be detected only with MRI. With adequate recognition of cerebellar infarction on MRI and prompt initiation or optimisation of preventive therapeutic measures, more dramatic strokes may be avoided in selected cases. Summary: We first briefly review the clinical presentation of cerebellar infarctions, followed by a short refresher on cerebellar anatomy and pathophysiological mechanisms of cerebellar infarcts. Then, we review the arterial cerebellar perfusion territories recently made visible with territorial arterial spin labeling (ASL), followed by a discussion and illustration of the MRI appearance of cerebellar infarcts in different stages. Similar to large cerebellar infarcts, recent studies investigating volumetric MRI datasets have now shown that small cerebellar infarcts occur in typical spatial patterns, knowledge of which may help in the diagnosis of even the smallest of cerebellar infarcts on MRI. Key Messages: MRI is the modality of choice for diagnosing cerebellar infarction. The posterior inferior cerebellar artery (PICA)-territories can be visualised with super-selective territorial ASL MRI. The PICA supplies at least the medial part of the posterior cerebellar surface. Anterior inferior cerebellar artery-infarcts can be mistaken for lateral PICA-infarcts. Small infarcts typically affect the cortex and often present as incidental cavities. Subacute cerebellar infarcts may be missed on imaging due to a phenomenon called “fogging.”

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The Cerebellar Arteries: Cortical Patterns and Vascularization of the Cerebellar Nuclei

Cited by 30 publications

References 7 publications

Very Small Cerebellar Infarcts: Integration of Recent Insights into a Functional Topographic Classification

Very Small Cerebellar Infarcts: Integration of Recent Insights into a Functional Topographic Classification

Vascularisation of the cerebellar nuclei in Akkaraman sheep

MRI of Cerebellar Infarction

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