Cerebellar atrophy with basilar artery occlusion.

Small and large vessel occlusive disease leading to chronic cerebral ischemia and brain atrophy is a concept originating in the last century. The modern notion of acute brain infarct, however, appears to have eclipsed the idea of chronic hypoperfusion as an important factor in ischemic cerebral damage. We present a patient history featuring recurrent episodes of acute posterior circulation infratentorial ischemia in addition to a progressive cerebellar syndrome over a course of several years. Laboratory work-up including cerebral angiography, repeated CT and MR scanning revealed basilar artery occlusion, a pontine infarct and a subsequently developing cerebellar atrophy without signs of cerebellar infarction. Findings indicating causes of cerebellar atrophy other than ischemia could not be elicited. We offer the hypothesis that basilar artery occlusion, inducing subsequent chronic ischemia, is the most likely cause of the cerebellar atrophy observed in our case.