Other less common causes include mechanical trauma to the vertebral artery in the neck, vertebral arteritis (inflammation of the wall of the artery), aneurysm of the vertebral artery, arteriovenous malformations. At the bottom, the Posterior Inferior Cerebellar Artery (PICA) is the latest addition to cerebellar supply, Unlike AICA and SCA, it seems to arise from the lateral spinal system (yet nervertheless also a coronary artery homolog). The most striking findings of whole PICA territory infarction are vertigo, vomiting at onset, disturbances of consciousness, and sensorimotor deficits resulting. The most common cause of Wallenberg syndrome is an ischemic stroke of the brain stem, oftentimes a result from thrombus or embolism. It becomes of crucial importance when cerebellar infarction is the prelude to cerebellar swelling and brain stem conpression leading to coma and death unless surgically relieved. At the mid to lower basilar segment, a homologous enlarging channel is the AICA. Recognition of a syndrome corresponding to cerebellar infarction in the PICA territory is important insofar as it assists in the differential diagnosis of dizziness. In two cases, the clinical diagnosis had been a benign labyrinthine disorder. The stroke mechanism is thought to be artery-to-artery embolization from the left vertebral artery proximal to the orifice of the left posterior inferior cerebellar artery. The clinical manifestations consisted of rotatory dizziness intensified by motion, nausea, vomiting, imbalance, and nystagmus. When performing the clinical HIT, clinicians should compare the leftright difference in size of compensatory saccades, and be cognizant that bilateral saccades suggest AICA stroke, small or no saccade PICA/SCA strokes, and unilaterally dominant large saccades VN. Brain MRI and MRA (a) show left cerebellar infarction in the PICA territory (left panel) and diffuse stenosis of the left vertebral artery (right panel). We have studied three cases, two clinocaopthologically and one clinicosurgically, in which an acute infarct involving only the cerebellum lay in the PICA territory distal to the branches to the medulla oblongata. One month after stroke onset, the patient still presented with visuoconstructive apraxia, left superior quadrantanopsia, mild left hemihyperesthesia, and hyperreflexia. Although old or recent infarcts of a cerebellar hemisphere in the territories of the posterior inferior (PICA), superior, or anterior inferior cerebellar arteries are commonplace autopsy findings, in no case have corresponding clinical symptoms been clearly identified.
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