Cerebellar infarction: Prognosis and complications of vascular territories

Introduction: Cerebellar infarction (CI) is uncommon, but may result in severe complications. The aim of our study was to determine the characteristics of patients with CI, as well as their outcomes as regards the territories affected. Patients and methods: Data were collected from 124 patients admi...

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Bibliographic Details
Main Authors: L.M. Cano, P. Cardona, H. Quesada, P. Mora, F. Rubio
Format: Article
Language:English
Published: Elsevier España 2012-07-01
Series:Neurología (English Edition)
Online Access:http://www.sciencedirect.com/science/article/pii/S2173580812001150
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Summary:Introduction: Cerebellar infarction (CI) is uncommon, but may result in severe complications. The aim of our study was to determine the characteristics of patients with CI, as well as their outcomes as regards the territories affected. Patients and methods: Data were collected from 124 patients admitted to our department during a five-year period, with a radiological diagnosis of CI, and with or without involvement of other brain territories. Results: The mean age in our series was 65.2 years, with most being male (68.5%). The posterior inferior cerebellar artery (PICA) was the most commonly affected territory at 49.2%, followed by superior cerebellar artery (SCA) at 17.7%, and anterior inferior cerebellar artery (AICA) at 10.5%. There was simultaneous supratentorial involvement in 13.7%, and two or three cerebellar arteries involved in 8.9%. The main aetiology in PICA was atherothrombosis (P = .02). On the other hand, cardio-embolism was the main origin in cases with more than one affected territory (P = .04). No particular aetiology could be found in SCA and AICA. There was haemorrhagic transformation in 29 patients (23.4%), particularly in the PICA and when other territories were involved. There was hydrocephalus in 15 patients (12.1%, 12 of them PICA; P = .02) in 2.9 ± 1.5 days from stroke onset. At discharge, the degree of disability was worse if more than one arterial territory was involved (Rankin ≥ 3, 64% versus 31–36%; P = .05). Four (3.2%) patients died. Conclusions: CI is very heterogeneous. Nevertheless, it is noteworthy that PICA infarction is the most frequent type and its aetiology is usually atherothrombotic. Moreover, it is the territory most frequently associated with severe complications, which take place during the first week of the stroke. Resumen: Introducción: Los infartos cerebelosos (IC) son infrecuentes pero pueden presentar complicaciones graves. Nuestro objetivo ha sido estudiar las características de los pacientes con IC, así como su evolución, en función del territorio afectado. Pacientes y métodos: Se han recogido datos de 124 pacientes ingresados en nuestro servicio durante un periodo de 5 años, con diagnóstico radiológico de IC, con y sin afectación de otras regiones cerebrales. Resultados: La edad media de nuestra serie es de 65,2 años, con predominio masculino (68,5%). El territorio más afectado fue la arteria cerebelosa posteroinferior (PICA) en el 49,2%, seguido de la arteria cerebelosa superior (ACS) en el 17,7% y cerebelosa anteroinferior (AICA) en el 10,5%. Se afectaron territorios supra-infratentoriales en el 13,7% y dos/tres territorios cerebelosos en el 8,9%. La etiología aterotrombótica fue más prevalente en PICA (p = 0,02) y la cardioembólica en la afectación de múltiples territorios (p = 0,04), siendo similares en ACS y AICA. Se produjo transformación hemorrágica en 29 pacientes (23,4%), sobretodo en la afectación de múltiples territorios y en PICA. Se asoció hidrocefalia en 15 pacientes (12,1%, 12 de ellos PICA; p = 0,02), apareciendo de media a los 2,9 ± 1,5 días del inicio del ictus. Al alta, la dependencia funcional (Rankin ≥ 3) era mayor si la afectación territorial era múltiple (64% vs 31-36%; p = 0,05). Se contabilizaron 4 defunciones (3,2%). Conclusiones: Los IC tienen gran heterogeneidad. Sin embargo, cabe destacar que los infartos de PICA son los más prevalentes, su etiología suele ser aterotrombótica y son los más asociados a complicaciones graves, que ocurren durante la primera semana del ictus. Keywords: Cerebellar infarction, Cerebellum, Hydrocephalus, PICA, Stroke, Palabras clave: Cerebelo, Hidrocefalia, Ictus, Infarto cerebeloso, PICA
ISSN:2173-5808