Introduction:

Cerebellar infarct can present with a broad spectrum of clinical and radiographic features. Recognizing this spectrum is extremely important for prompt diagnosis and to avoid morbidity and mortality.

Objective:

To identify the clinical and radiological profile of patients presenting with isolated acute cerebellar infarct.

Methods:

Retrospective study carried out at the central stroke unit of Oman over 27 months. Only patients with isolated acute cerebellar infarct confirmed by either magnetic resonance imaging or computerized tomography (CT) were included in this study. A total of 76 cases were identified.

Results:

Isolated cerebellar infarct constituted 4% of all acute ischemic strokes treated during the study period. Gait imbalance and difficulty in articulating were seen in 30/48 (63%) and 12/48 patients (25%), respectively. Ataxia and nystagmus were the main signs seen 30/48 (63%) and 10/48 (21%), respectively. Large artery atherosclerosis comprised 15/48 (31%), of the underlying etiology. Normal and complete posterior circulation was seen only in 6/36 (17%). Unilateral or bilateral hypoplasia or absence of posterior communicating artery (PCOM) were the commonest variants seen in our patients. The cerebellar arterial territory most commonly involved in this series was posterior inferior cerebellar artery (58%). Infarct extension was seen in 10/48 patients (21%), with 4/10 (40%) having bilateral absent PCOM followed by 2/10 (20%) normal posterior circulation.

Conclusions:

Acute gait imbalance and difficulty in articulating can be the only presenting symptoms in isolated cerebellar infarct. Plain CT in the acute phase can miss such infarcts in up to 46% cases. The majority of cases had an incomplete anatomy of the posterior circulation.