![]() It forms three loops, one at the cerebello-medullary junction, second at the cranial part of cerebellar tonsil and the third at the inferior vermis.5 A medial branch and a lateral branch are given between the first two loops. PICA arises from the vertebral artery (VA) and courses transversely along the medulla. PICA territory strokes form about 40% of them. She was managed conservatively with antiplatelets, statins and physiotherapy and showed good clinical improvement.Ībout 2% of acute strokes involve the cerebellum. Work up for procoagulant states was negative. Electrocardiogram and transthoracic echocardiogram were within normal limits. The relatives did not consent for a digital subtraction angiogram. Time-of-flight (TOF) Magnetic resonance angiography (MRA) (Figure 1B) showed diffuse vertebrobasilar disease. MRI of the brain showed bilateral, nearly symmetrical PICA infarction (Figures 1A, 1C and 1D). Random blood sugar was 178 mg% and HbA1c 8.2 %. Blood counts and biochemical analysis were normal. There was no past medical history of hypertension and cardiovascular disease. There were no signs of involvement of other long tracts and cranial nerves. On examination, she had bilateral horizontal gaze evoked nystagmus and limb ataxia. Case ReportĪ 48- years lady, a diabetic presented in the emergency room with sudden onset of vertigo and unsteadiness. Infarctions in the medial PICA territories and discuss the possibleĬauses of such a presentation. Only few such cases are reported in literature soįar.1-4 Here we report a lady who presented with bilateral cerebellar Simultaneous cerebellar infarctions in the medial PICA territories areĮxtremely rare. ![]() The origin of PICA arises from a single vertebral artery (VA). Inferior cerebellar artery (PICA) are rare. Strokes in the distribution of the posterior Generally have a good prognosis considering the very small area of blood We also list out the possible mechanisms ofīilateral medial PICA territory infarction. Supply along with the clinical features differentiating the medial and We discuss the anatomical peculiarities of PICA and its blood She was aĭiabetic and had features of diffuse atherosclerotic vertebrobasilarĭisease. ![]() We report one such patient who presented with acute bilateralĬerebellar infarctions in the medial PICA territories. Sudden simultaneousĬerebellar infarctions in the medial PICA territories are extremely Lateral division or the medial division of PICA. Strokes involving posterior inferior cerebellar arteries ![]()
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