Brusa L, Iannilli M, Bruno G, Di Biasi C, Gualdi G F, Schiaffini C, Lenzi G L
Dipartimento di Scienze Neurologiche, Università di Roma La Sapienza, Italy.
Ital J Neurol Sci. 1996 Dec;17(6):433-6. doi: 10.1007/BF01997719.
We present an unusual case of simultaneous bilateral cerebellar infarction in the territory of the medial and intermediate branches of the posterior inferior cerebellar arteries (mPICA). The patient, a 57-yr-old woman, had no risk factors for cerebrovascular disease but a long-standing hypertension. Pathogenetic hypotheses of this unusual ischemic site of lesion may be referred to: A) two PICAs arising from an occluded basilar artery; B) both medial branches arising from the same PICA on one side; C) a haemodynamic mechanism with hypoperfusion in the most peripheral branches of the arteries; D) a double, simultaneous embolic stroke in mPICAs territory. Based on clinical course, supraortic duplex-scan, echocardiography, MRI, angioMRI and CT scans, and digital subtraction angiography, none of these hypotheses could be clearly associated with the pathogenesis of the lesion. Nevertheless, we propose that an anomalous common mPICA for both cerebellar territories should represent the necessary condition for the ischemic insult and, simultaneously, other factors should intervene as possible determining events.
我们报告了一例罕见的双侧小脑梗死病例，梗死区域位于小脑后下动脉（mPICA）内侧和中间分支供血区。患者为一名57岁女性，无脑血管疾病危险因素，但患有长期高血压。这种罕见缺血性病变部位的发病机制假说可能如下：A）两条PICA均起源于闭塞的基底动脉；B）两侧的内侧分支均起源于同一侧的PICA；C）一种血流动力学机制，即动脉最外周分支灌注不足；D）mPICA供血区内同时发生的双侧栓塞性卒中。基于临床病程、主动脉弓双功超声扫描、超声心动图、MRI、血管造影MRI和CT扫描以及数字减影血管造影，这些假说均无法明确与病变的发病机制相关。然而，我们认为，双侧小脑区域存在异常的共同mPICA应是缺血性损伤的必要条件，同时，其他因素可能作为决定性事件参与其中。
