J Korean Neurosurg Soc.  2017 May;60(3):362-366. 10.3340/jkns.2014.0102.017.

Contralateral Superior Cerebellar Artery Syndrome: A Consequence of Brain Herniation

Affiliations
  • 1Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • 2Department of Pediatric Neurosurgery, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. zohreh_h56@yahoo.com

Abstract

Vascular compromise is a well-known consequence of brain herniation syndromes. Transtentorial brain herniation most often involves posterior cerebral arteries. However, isolated involvement of contralateral superior cerebellar artery (SCA) during unilateral impending brain herniation is reported only once and we present another case of this exceedingly rare entity. A 24-year-old man was referred to us with impending herniation due to a multiloculated hydrocephalus, and during the course of illness, he developed an isolated SCA ischemia in the opposite side of the most dilated entrapped horn. In the current article we discuss the probable pathophysiologic mechanisms of this phenomenon, as well as recommending more inclusive brain studies in cases suspected of Kernohan-Woltman notch phenomenon in unilateral brain herniation. The rationale for this commentary is that contralateral SCA transient ischemia or infarct might be the underdiagnosed underlying pathomechanism of ipsilateral hemiparesis occurring in many cases of this somehow vague phenomenon.

Keyword

Superior cerebellar artery; Stroke; Cerebral hernia; Contralateral

MeSH Terms

Animals
Arteries*
Brain*
Encephalocele
Horns
Humans
Hydrocephalus
Ischemia
Paresis
Posterior Cerebral Artery
Stroke
Young Adult

Figure

  • Fig. 1 A: Axial FLAIR brain MRI demonstrating multiple intraventricular septations causing biventricular hydrocephalus with periventricular edema on the right side and midline shift to the left. B: Infratentorial axial T2 weighted image showing normal left SCA territory at the first admission. C: Brain MRI after microsurgical fenestration showing relieved intraventricular loculation. D: Brain CT on readmission demonstrating severe hydrocephalus with trapped trigone and temporal horn of right lateral ventricle and midline shift to the opposite side. E: Brain CT after EVD procedure showing improved hydrocephalus and relieved sulcal effacement. F–H: Axial T2 MRI, diffusion weighted imaging, and apparent diffusion co-efficient map after patient’s deterioration in the second admission demonstrating left SCA ischemic infarct. FLAIR: fluid-attenuated inversion recovery, MRI: magnetic resonance imagine, SCA: superior cerebellar artery, EVD: external ventricular drainage.

  • Fig. 2 A: Coronal T2 image in the phase of unilateral supratentorial hypertension showing upper basilar artery and its tributaries being distorted anatomically (arrows) potentially due to the right medial temporal lobe sliding down through the tentorial notch. B: Coronal T2 image following supratentorial decompression demonstrating the aforementioned structures regaining their normal anatomical relationships. C: Brain CT-angiography showing left SCA being patent with no other vascular compromise throughout the whole territory. SCA: superior cerebellar artery.


Reference

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