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Images in Neurology |

Cerebellar Hypoperfusion in a Patient With Spells of Imbalance

Claudia Chaves, MD; Thomas Piemonte, MD; Grace Lee, MD
Arch Neurol. 2008;65(11):1540-1541. doi:10.1001/archneur.65.11.1540.
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Perfusion computed tomography (PCT) is an imaging modality that allows identification of tissue that is at risk in patients with cerebrovascular disease.1 We describe a patient with spells of imbalance and cerebellar hypoperfusion documented by PCT with normalization of clinical and imaging findings after an angioplasty with stent of the right vertebral artery origin (RVAo).

An 80-year-old man with a history of hypertension, coronary artery disease, and dyslipidemia presented to the clinic with 10 stereotypical spells of imbalance, veering toward the right often triggered by postural changes, for the past 6 months. Findings from a neurological examination were normal.

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Figure 1.

Initial magnetic resonance angiography showing 90% stenosis of the right vertebral artery origin (A, arrow) and normal magnetic resonance image (B [DWI] and C [FLAIR]) of the head. Perfusion computed tomography showing increased relative mean transit time (D), normal relative cerebral blood volume (E), and decreased relative cerebral blood flow (F) in the right posterior inferior cerebellar artery territory. DWI indicates diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery.

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Figure 2.

Follow-up computed tomographic angiography. A, Magnetic resonance angiography of the neck; B-D, perfusion computed tomography showing recanalization of the right vertebral artery origin (arrow in A) and normalization of the cerebellar perfusion. rMTT indicates relative mean transit time; rCBV, relative cerebral blood volume; and rCBF, relative cerebral blood flow.

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