Clinical Neurology and Neurosurgery 103 (2001) 194 – 196 Case report Acute bilateral cerebellar infarction in the territory of the medial branches of posterior inferior cerebellar arteries Gunfer Gurer a, *, Gurdal Sahin a , Saruhan Cekirge b , Ersin Tan a , Okay Saribas a a Department of Neurology, Hacettepe Uniersity Hospitals, Ankara, Turkey b Department of Radiology, Hacettepe Uniersity Hospitals, Ankara, Turkey Received 23 October 2000; accepted 14 May 2001 Abstract The most frequent type of cerebellar infarcts involved the posterior inferior cerebellar artery (PICA) and superior cerebellar artery territories but bilateral involvement of lateral or medial branches of PICA is extremely rare. In this report, we present a 55-year-old male who admitted to hospital with vomiting, nausea and dizziness. On examination left-sided hemiparesia and ataxic gait were detected. Infarct on bilateral medial branch of PICA artery territories was found out with cranial magnetic resonance imaging (MRI) technique and 99% stenosis of the left vertebral artery was found out with digital subtraction arteriography. The patient was put on heparin treatment. After 3 weeks, his complaints and symptoms had disappeared except for mild gait ataxia. © 2001 Elsevier Science B.V. All rights reserved. Keywords: Cerebellar infarction; Posterior inferior cerebellar artery; Magnetic resonance imaging www.elsevier.com/locate/clineuro 1. Introduction Cerebellar infarctions usually occur in the territories of posterior inferior cerebellar artery (PICA) and supe- rior cerebellar artery [1]. Among PICA infarctions oc- clusion of medial and lateral branches are rare and had good prognosis [2]. Occlusion of distal medullary branches of PICA, including the medial branch (mPICA) causes vertigo with or without ipsilateral axial lateropulsion and other types of cerebellar ataxias. Only a few clinicopathological and clinicoradiological studies of infarcts in territory of medial branches of PICA have been reported [3,4]. We describe a clinicora- diological study of a patient with bilateral mPICA infarction. 2. Case report A 55-year-old man was admitted to our hospital with transient, sudden loss of consciousness. His past medi- cal history revealed coronary by-pass grafting 2 weeks ago on left anterior descending coronary artery. On admission to hospital he was oriented. His blood pres- sure was 160/70 mmHg and pulse rate was 76 min -1 . No carotid bruit could be detected. On neurological examination, left-sided homonymous hemianopia, cen- tral facial palsy, hemiparesis and hemineglect were de- tected. Cranial computerised tomography (CT) scan was normal. The patient was anticoagulated with hep- arin as an embolic infarction could not be ruled out. His symptoms were fully recovered in 10 h. After 22 h, he woke up at night with sudden onset vertigo, nausea, vomiting and diplopia. On neurological examination only gait ataxia could be detected and no lesion was present on cranial CT which was performed 1 h after the onset of symptoms. After 6 h, his symptoms except vertigo were recovered. Gait ataxia and mild truncal ataxia were detected. Cranial magnetic resonance imag- * Corresponding author. Tel.: +90-312-305-1806; fax: +90-312- 309-3451. E-mail address: gunfism@ada.net.tr (G. Gurer). 0303-8467/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved. PII:S0303-8467(01)00139-1