Umashankar Gopalan, Gupta Vivek, Harik Sami I
Department of Neurology, University of Arkansas College of Medicine, Little Rock, AR 72205, USA.
Arch Neurol. 2004 Jun;61(6):953-6. doi: 10.1001/archneur.61.6.953.
Bilateral simultaneous infarction in the territories of the posterior inferior cerebellar arteries (PICAs) is rare but was recently reported with increasing frequency, probably because of the wider availability of magnetic resonance imaging. The cause of these infarcts is believed to be atherosclerotic or embolic occlusion of a dominant PICA, which perfused the territories of the medial branches of both PICAs.
We encountered a patient with simultaneous infarction in the territories of the medial branches of both PICAs. The clinical course, imaging results, and laboratory findings are presented. The patient was diagnosed with neurosyphilis based on a history of chancre, positive serum and cerebrospinal serologies, cerebrospinal pleocytosis, and increased intrathecal immunoglobulin synthesis. We believe that meningovascular syphilis caused the bilateral cerebellar infarct via presumed thromboangiitis of a dominant PICA perfusing both cerebellar hemispheres. The patient was treated with intravenous high doses of penicillin.
This case reminds us that meningovascular syphilis should be considered in younger patients with stroke. Patients with bilateral cerebellar infarction may solely have symptoms of vertigo and ataxia but can develop life-threatening complications because of edema of the infarcted tissue with resultant hydrocephalus and pressure on the brainstem.
双侧小脑后下动脉（PICA）供血区同时发生梗死较为罕见，但近期报道的频率有所增加，这可能是由于磁共振成像的普及程度更高。这些梗死的原因被认为是优势PICA的动脉粥样硬化或栓塞性闭塞，该优势PICA为双侧PICA内侧分支的供血区供血。
我们遇到了一名双侧PICA内侧分支供血区同时发生梗死的患者。本文介绍了其临床病程、影像学结果及实验室检查结果。该患者根据有硬下疳病史、血清和脑脊液血清学检查呈阳性、脑脊液细胞增多以及鞘内免疫球蛋白合成增加，被诊断为神经梅毒。我们认为，脑膜血管梅毒通过灌注双侧小脑半球的优势PICA的血栓性血管炎导致了双侧小脑梗死。该患者接受了大剂量静脉青霉素治疗。
该病例提醒我们，对于年轻的卒中患者应考虑脑膜血管梅毒。双侧小脑梗死患者可能仅出现眩晕和共济失调症状，但由于梗死组织水肿导致脑积水和脑干受压，可能会出现危及生命的并发症。
