Teaching NeuroImage: Bilateral Middle Cerebellar Peduncle Stroke in Giant Cell Arteritis

A 78-year-old man presented with weeks of progressive fatigue and dysarthria. Brain MRI showed symmetrical middle cerebellar peduncle (MCP) infarctions (Figure, A, B, E). CT angiography showed multifocal bilateral cervical vertebral artery stenoses (Figure, H). Symptoms worsened over 2 weeks, despite antiplatelet therapy. Repeat MRI showed enlargement and mild enhancement of the MCP lesions (Figure, C, D, F, G). CRP was 185 mg/L, and ESR was 97 mm/h. Temporal artery biopsy revealed non-necrotizing arteritis (Figure, I). Isolated lesions of bilateral MCPs are extremely rare and arise from vascular, degenerative, inflammatory, and neoplastic disorders.(1,2) Giant cell arteritis is a rare cause of stroke and tends to preferentially affect the vertebrobasilar system.

Automated summary

A 78-year-old man presented with progressive fatigue and dysarthria. MRI showed symmetrical middle cerebellar peduncle infarctions, while CT angiography revealed multifocal bilateral cervical vertebral artery stenoses. Despite antiplatelet therapy, symptoms worsened over 2 weeks. Repeat MRI showed enlargement and mild enhancement of the lesions. Blood tests indicated elevated inflammatory markers, and temporal artery biopsy confirmed non-necrotizing arteritis. Giant cell arteritis is a rare cause of stroke, particularly affecting the vertebrobasilar system.