Multiple cerebellar infarcts: clinical and pathophysiologic features.

We investigated the clinical features of 15 patients with multiple isolated ischemic lesions in the cerebellum. The main initial symptoms were vertigo and nausea/vomiting in 8 patients each, and headache in 6 patients. Dysarthria and cerebellar ataxia of the limbs and trunk were observed in 14 patients. The ischemic lesions were in the posterior inferior cerebellar artery (PICA) plus superior cerebellar artery (SCA) territories in 4 patients (27%), and PICA plus SCA plus anterior inferior cerebellar artery (AICA) territories in 3 patients (20%). Infarcts were in the AICA plus SCA territories in 2 patients (13%), PICA only in 2 patients (13%), and SCA only in 4 patients (27%). Hemorrhagic lesions were observed in the ischemic area in 2 patients (13%). Vascular lesions included occlusive lesions of the vertebral arteries in 9 patients (60%), but no abnormalities of the vertebrobasilar arterial system were observed in 6 patients (40%). The functional prognosis was good in most cases. The underlying mechanism was atherothrombotic, including arteriogenic embolism in 9 patients (60%) and cardiogenic embolism in 3 patients (20%). An embolic mechanism was considered in all cases, but in some cases an accurate pathogenesis of the cerebellar infarction was obscure.