Abstract
Objective: To investigate the characteristics of vascular lesions in patients with a cerebellar watershed infarction. Methods: Clinical data from 178 cases of cerebellar infarction were collected with magnetic resonance imaging (MRI) scan results, including diffusion weighted imaging (DWI), a magnetic resonance angiography (MRA), and computed tomography angiography (CTA). The cases were divided into cerebellar watershed and non-watershed infarctions based on lesion location, which was revealed by DWI. Forty-two cases met the criteria for a cerebellar watershed infarction. Based on the MRA/CTA results, the vertebrobasilar artery stenoses were divided into four categories (i.e., intracranial, extracranial, combined, and no detectable stenosis) to compare the vascular lesion characteristics from patients with a cerebellar watershed infarction and patients with a non-watershed infarction. Results: Patients with cerebellar watershed infarcts presented mild symptoms at onset and had a favorable prognosis. However, 90.5% of these patients had a vascular stenosis, which was higher than for patients with a cerebellar non-watershed infarction (74.3%). The four types of vascular lesions, intracranial, extracranial, combined, and no detectable stenosis, were 14.3%, 52.4%, 23.8%, and 9.5% in patients with a cerebellar watershed infarction and 33.8%, 16.2%, 24.3%, and 25.7% in patients with a non-watershed cerebellar infarction, respectively. Conclusion: Although patients with cerebellar watershed infarcts often had comparatively benign clinical manifestations and prognoses, such patients also had a high stenosis prevalence in major blood vessels, especially the extracranial segment in the vertebral artery, which required early intervention and treatment.
Highlights
A cerebellar watershed infarction is a rare type of brain infarction
The inclusion criteria required the following: 1) infarction involved with the cerebellum, which was confirmed as an acute cerebellar infarction through DWI; 2) magnetic resonance imaging (MRI), diffusion weighted imaging (DWI), and magnetic resonance angiography/computed tomography angiography (MRA/CTA) examinations completed within 1 week of onset; 3) blood examinations, including routine blood test, blood coagulation, fibrinogen, homocysteine, blood glucose, blood lipids, electrolytes, liver and kidney function, as well as an electrocardiogram and echocardiogram, completed within 1 week of onset
The NIHSS score for the watershed infarction group decreased from 2.33 ± 1.69 to 1.64 ± 1.19 (t = 2.166, P = 0.033), and the non-watershed infarction group’s score increased from 4.21 ± 2.39 to 4.88 ± 4.44 (t = 1.593, P = 0.112), which indicates that a cerebellar watershed infarction yields a good short-term prognosis
Summary
A cerebellar watershed infarction is a rare type of brain infarction. In 1993, Amarenco et al [1] reported 47 patients with very small (border zone) cerebellar infarcts and revealed that large or pial artery disease rather than systemic hypotension was the main vascular lesion. The small cerebellar infarcts were recommended a new classification system based on topography in recent study [2]. A limited number of studies on cerebellar watershed infarction have been published, and the pathogenesis, clinical manifestations, location of vascular lesions, and prognosis for this disease are still unclear. We collected 42 cases with a cerebellar watershed infarction and analyzed the clinical and imaging features to understand the corresponding vascular pathogenesis that was helpful to the therapy and secondary prevention of this rare disease
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