Bilateral Middle Cerebellar Peduncle Stroke in Giant Cell Arteritis

Confidential. © 2021 American Academy of Neurology 1

Resident & Fellow Section Teaching NeuroImage

A 78-year-old man with bilateral middle cerebellar peduncle lesions

Aghajan Y, et al.

Confidential. © 2021 American Academy of Neurology 2

Vignette

78-year-old previously healthy man presents with weeks of fatigue and dysarthria

Brain MRI shows symmetric middle cerebellar peduncle lesions

CTA shows multifocal bilateral cervical vertebral artery stenoses

CRP was 185 mg/L, ESR was 97 mm/h

Symptoms worsen over two weeks despite anti-platelet agents

Repeat MRI shows enlargement and mild enhancement of lesions

Temporal artery biopsy shows non-necrotizing active arteritis

Diagnosed with Giant Cell Arteritis

Aghajan Y, et al

Confidential. © 2021 American Academy of Neurology 3

Imaging

Aghajan Y, et al

Confidential. © 2021 American Academy of Neurology 4

Bilateral Middle Cerebellar Peduncle Stroke in Giant Cell Arteritis

 Isolated lesions of bilateral MCPs are extremely rare

 Differential includes vascular, degenerative, inflammatory, neoplastic

 Giant cell arteritis (GCA) is a rare cause of stroke, but preferentially affects the vertebrobasilar system

 Think of GCA whenever you see isolated posterior circulation

infarcts with non-atherosclerotic cervical vessel stenosis, especially with an elevated ESR.

Aghajan Y, et al