Presentation
Vertigo and persistent vomiting for one day.
Patient Data
Large hypoattenuating area with mild mass effect involving the posteroinferior aspect of the right cerebellar hemisphere. It is effacing the fourth ventricle causing minimal dilatation of the proximal ventricular system.
Acute ischemic infarct involving the inferior posterior aspect of the right cerebral hemisphere and right side of the vermis; right posterior inferior cerebellar artery (PICA) territory.
The involved area is returning a high signal on T2/FLAIR sequences with diffusion restriction. No post-contrast enhancement. No evidence of hemorrhage.
Interval increase in the extent of hydrocephalus compared to the CT exam.
CONCLUSION:
Acute ischemic infarct in right posterior inferior cerebellar artery (PICA) territory with mass effect over fourth ventricle and mild proximal acute hydrocephalus. No evidence of hemorrhagic transformation.
Case Discussion
Vertigo, nausea, and truncal ataxia are the most common presenting features of posterior inferior cerebellar artery territory infarct.
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