Two cases of cerebellar infarction in the territory of the PICA due to cervical occlusive injuries

Abstract

Recently, because of the development of MRI, it is becoming apparant that there are some cases of cerebellar vascular disorder in the posterior cranial fossa among cases of sudden onset of rotatory vertigo. We reported two cases of sudden onset of rotatory vertigo caused by cerebellar infarction in the territory of the posterior inferior cerebellar artery (PICA) due to cervical occlusive injuries. Case 1. A 48-year-old male sustained a slight whip lash injury and after ten hours, experienced rotatory vertigo and hoarseness. When he came to our hospital, we could only detect hoarseness. However, vascular disorder in the posterior cranial fossa was suggested by the interview. MRI revealed left cerebellar and medulla oblongata infarction. Case 2. A 29-year-old male felt rotatory vertigo and vomited after clicking his neck. Upon closer examination, pure rotatory spontaneous nystagmus, sensory disorder accompanied by sensory dissociation in his face and disability in standing and walking were found, suggesting vascular disorder in the posterior cranial fossa. MRI showed infarction in the left inferior cerebellar region, vermis and left lateral-dorsal medulla oblongata. A dissecting aneurysm in the verteblar artery was found on subsequent angiography. In the Japanese literature, we could find only nine reported cases of cerebellar vascular disorder in the posterior cranial fossa due to the cervical occlusive injuries, in addition to our two cases. The severity of injuries and the period until onset of diagnostic symptoms varied. Therefore, tracing cerebellar vascular disorders due to cervical occlusive injury required not only neurological and neuro-otological findings, but also attention to the history of the original injury and the development of subsequent symptoms. Without a careful interview, it is very difficult to correctly establish the cause of the disorder.