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Inverted V or rabbit ear sign in cerebellum.

Eswaradass PV, Gnanashanmugham G, Parimalam N, Pranesh MB - J Neurosci Rural Pract (2015 Jul-Sep)

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.

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There was no past history of myocardial infarction, transient ischemic attack (TIA) or stroke... MR imaging of brain revealed acute infarts in inferior cerebellum in the bilateral medial PICA (posterior inferior cerebellar artery) territories [Figure 1]... Magnetic resonance angiogram (MRA) did not reveal any abnormality... We encountered a rare case of inverted “V” or rabbit ear sign in cerebellum... Cerebellum is supplied by PICA, anterior inferior cerebellar artery and superior cerebellar artery... Simultaneous bilateral cerebellar infarctions in PICA territory, without brain stem involvement, are rare... Rarely double embolic stroke affecting both medial PICA can cause this type of infarction... In our case, DSA showed non-opacification of bilateral PICA with normal vertebral arteries and did not reveal any anatomical variant... The hypothesis made by Kang et al. may fit this case... On one side, PICA could be a hypoplastic one, resulting in non-opacification... Neurologist must be aware of rare bilateral simultaneous medial PICA infarcts, as they may initially present only with ataxia or vertigo and may worsen subsequently due to edema of the infarct... The resultant pressure on the brainstem and obstruction of CSF flow can cause progressive coma... Bilateral PICA infarction in cerebellum can mimic inverted “V” sign of SACD.

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(a and b) MRI DWI shows bilateral inverted V shaped infarct in PICA territory
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Figure 1: (a and b) MRI DWI shows bilateral inverted V shaped infarct in PICA territory

Mentions: We report a 55-year-old female who presented to us with history of sudden onset of vertigo, vomiting and ataxia for 2 days duration. The patient is a known hypertensive on regular treatment for last 7 years. She was also a recently detected diabetic on oral hypoglycemic therapy. There was no past history of myocardial infarction, transient ischemic attack (TIA) or stroke. On examination, she had bilateral gaze evoked nystagmus, bilateral finger nose incoordination and gait ataxia. There was no long tract signs to suggest involvement of brainstem. All peripheral pulses were felt and regular in rhythm. Clinically, cardiovascular system was normal. MR imaging of brain revealed acute infarts in inferior cerebellum in the bilateral medial PICA (posterior inferior cerebellar artery) territories [Figure 1]. Magnetic resonance angiogram (MRA) did not reveal any abnormality. Digital subtraction angiography (DSA) showed bilateral occlusion of PICA. Vertebral arteries were normal [Figure 2]. She made good recovery without any complications and was discharged with minimal gait ataxia after 10 days.


Inverted V or rabbit ear sign in cerebellum.

Eswaradass PV, Gnanashanmugham G, Parimalam N, Pranesh MB - J Neurosci Rural Pract (2015 Jul-Sep)

(a and b) MRI DWI shows bilateral inverted V shaped infarct in PICA territory
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4481812&req=5

Figure 1: (a and b) MRI DWI shows bilateral inverted V shaped infarct in PICA territory
Mentions: We report a 55-year-old female who presented to us with history of sudden onset of vertigo, vomiting and ataxia for 2 days duration. The patient is a known hypertensive on regular treatment for last 7 years. She was also a recently detected diabetic on oral hypoglycemic therapy. There was no past history of myocardial infarction, transient ischemic attack (TIA) or stroke. On examination, she had bilateral gaze evoked nystagmus, bilateral finger nose incoordination and gait ataxia. There was no long tract signs to suggest involvement of brainstem. All peripheral pulses were felt and regular in rhythm. Clinically, cardiovascular system was normal. MR imaging of brain revealed acute infarts in inferior cerebellum in the bilateral medial PICA (posterior inferior cerebellar artery) territories [Figure 1]. Magnetic resonance angiogram (MRA) did not reveal any abnormality. Digital subtraction angiography (DSA) showed bilateral occlusion of PICA. Vertebral arteries were normal [Figure 2]. She made good recovery without any complications and was discharged with minimal gait ataxia after 10 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

There was no past history of myocardial infarction, transient ischemic attack (TIA) or stroke... MR imaging of brain revealed acute infarts in inferior cerebellum in the bilateral medial PICA (posterior inferior cerebellar artery) territories [Figure 1]... Magnetic resonance angiogram (MRA) did not reveal any abnormality... We encountered a rare case of inverted “V” or rabbit ear sign in cerebellum... Cerebellum is supplied by PICA, anterior inferior cerebellar artery and superior cerebellar artery... Simultaneous bilateral cerebellar infarctions in PICA territory, without brain stem involvement, are rare... Rarely double embolic stroke affecting both medial PICA can cause this type of infarction... In our case, DSA showed non-opacification of bilateral PICA with normal vertebral arteries and did not reveal any anatomical variant... The hypothesis made by Kang et al. may fit this case... On one side, PICA could be a hypoplastic one, resulting in non-opacification... Neurologist must be aware of rare bilateral simultaneous medial PICA infarcts, as they may initially present only with ataxia or vertigo and may worsen subsequently due to edema of the infarct... The resultant pressure on the brainstem and obstruction of CSF flow can cause progressive coma... Bilateral PICA infarction in cerebellum can mimic inverted “V” sign of SACD.

No MeSH data available.


Related in: MedlinePlus