Bilateral middle cerebellar peduncle infarction caused by traumatic vertebral artery dissection.

Abstract

Infarction in the territory of the anterior inferior cerebellar artery (AICA), which supplies the middle cerebellar peduncle and inferior lateral pontine areas, is rare.1-3⇓⇓ We present here a 59-year-old man with infarction localized in the bilateral middle cerebellar peduncles. This infarction was considered to have been caused by bilateral traumatic vertebral artery dissection, which was confirmed by MRI and three-dimensional CT angiography. This patient had been treated by a psychologist for depression for >10 years. In the depressive state, he often used to hit his head on his car door handle and had a habit of rotating his neck frequently. On April 12, 1999, he noticed a floating sensation when driving his car. One hour later, he suddenly developed dizziness, unsteadiness of gait, and dysarthria, resulting in difficulty in walking. These symptoms continued for 1 week. On April 20, he was referred to our hospital. On admission he was alert, but his speech was explosive and scanning. Neurologic examination revealed bilateral horizontal nystagmus, bilateral hearing disturbance, and ataxia in all four limbs and the trunk, but otherwise there …