Bilateral infarcts in the territory of the superior cerebellar artery: Clinical presentation, presumed cause, and outcome

Backgrounds and purposeThe aim of this study was to document the clinical presentation, vascular topographic patterns, stroke mechanism, and outcome of bilateral infarcts in the territory of the superior cerebellar artery (SCA) based on data collected from a prospective acute stroke registry.MethodsWe studied the clinical and radiological features of 11 patients with bilateral infarctions in the territory of the SCA diagnosed by brain MRI.ResultsBilateral SCA infarcts represented 23.4% (11/47) of all SCA territory infarction. Bilateral SCA infarcts mostly associated with brainstem (n = 5), cerebral (n = 5), or non-SCA cerebellar lesions (n = 4). The most common clinical presentation at onset was sudden fall with axial lateropulsion and dysarthria (n = 6). In five patients with a coexisting infarct(s) in the brainstem, limb weakness and/or mental change were prominent and often masked the signs of cerebellar dysfunction. Six patients showed no stenosis or occlusion in the vertebrobasilar system on brain MRA. Five had an obvious cardiac source of emboli. Eight patients showed favorable outcomes with complete recovery or minimal disability, but three patients with additional extensive brainstem infarcts died within 1 week.ConclusionsBilateral SCA territory infarcts show variable clinical, vascular topographic, and prognostic features. They usually result from cardiac emboli.