Bilateral wallerian degeneration of middle cerebellar peduncles following unilateral pontine infarction

Abstract

Bilateral lesions of medial cerebellar peduncles are rare and are most frequently observed in acute cerebral infarction due to large-artery atherosclerosis, wallerian degeneration, neurodegenerative diseases (i.e. multiple system atrophy), inflammatory diseases (i.e. neuromyelitis optica, acute demyelinating encephalomyelitis), toxic encephalopathies (i.e. heroin abuse) and primary central nervous system lymphomas [3]. Wallerian degeneration regards progressive anterograde demyelination of the distal axons following injury to the proximal axon. As a result, fibrosis and atrophy of the affected fiber tracts occurs [2]. We present a case report of a patient with the rare finding of bilateral middle cerebral peduncle lesions, due to wallerian degeneration following pontine infarction. We further discuss differential diagnosis upon imaging findings and their clinical utility.