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NEUROIMAGES
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 326-328

Isolated infarction of the tonsil in the cerebellum


Medicine Department, Federal University of Santa Maria, Brazil

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253573

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How to cite this article:
Rissardo JP, Fornari Caprara AL. Isolated infarction of the tonsil in the cerebellum. Neurol India 2019;67:326-8

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Isolated infarction of the tonsil in the cerebellum. Neurol India [serial online] 2019 [cited 2019 Mar 18];67:326-8. Available from: http://www.neurologyindia.com/text.asp?2019/67/1/326/253573




A 62-year-old male patient presented with rotatory vertigo and nausea for a day. The subject reported that these symptoms began 3 months ago, were recurrent, and lasted approximately 1 min. However, he only sought medical assistance this time because the symptoms did not improve. His medical history included hypertension, aortic valve replacement, and smoking. The neurological examination showed severe truncal and gait ataxia, normal head impulse test, negative skew deviation, gaze-evoked nystagmus when looking to the side of the lesion, and right truncal lateropulsion. In addition, when the subject was walking with assistance after two steps, he veered to the opposite direction of the lesion. Laboratory tests were within normal limits. A cranial noncontrast computed tomography (CT) scan and a brain magnetic resonance imaging (MRI) revealed a lesion in the cerebellar vermis [Figure 1]. A cranial CT angiography exhibited mild stenosis of the bilateral vertebral arteries.
Figure 1: Neuroimages showing left-sided caudal cerebellar vermis infarction (indicated by the arrows). Axial (a) coronal (b), and sagittal (c) views of cranial noncontrast CT scan. Sagittal (d); axial noncontrast (e), and axial contrast enhancement (f); T2-weighted; coronal (g); T1-weighted axial (h); sagittal fluid-attenuated inversion recovery (i); axial diffusion-weighted (j); and, axial apparent diffusion coefficient views of brain MRI (k)

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Isolated infarction of the tonsil in the cerebellum is rare. We identified two cases after a review of the English-language literature and we compared them with the present case [Table 1].[1],[2] This report supports the hypothesis that possibly the tonsil inhibits the vestibular nucleus of the ipsilateral side, like the nodulus,[2] since the clinical manifestations of the reported subject overlap with the typical symptoms of a cerebellar nodulus infarction. Furthermore, we agree with the statement of Calic et al., and Ogawa et al., that any patient presenting with a small cerebellar infarction needs to be investigated for a cardiac source of embolism and vascular risk factors.[2],[3]
Table 1: Reported cases of subjects with infarction of the tonsil in the cerebellum

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lee SH, Park SH, Kim JS, Kim HJ, Yunusov F, Zee DS. Isolated unilateral infarction of the cerebellar tonsil: Ocular motor findings. Ann Neurol 2014;75:429-34.  Back to cited text no. 1
    
2.
Ogawa K, Suzuki Y, Akimoto T, Morita A, Hara M, Yoshihashi H, et al. Clinical study on 3 patients with infarction of the vermis/tonsil in the cerebellum. J Stroke Cerebrovasc Dis 2018;27:2919-25.  Back to cited text no. 2
    
3.
Calic Z, Cappelen-Smith C, Cuganesan R, Anderson CS, Welgampola M, Cordato DJ. Frequency, aetiology, and outcome of small cerebellar infarction. Cerebrovasc Dis Extra 2017;7:173-80.  Back to cited text no. 3
    


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