title: Acute bilateral inferior cerebellar infarction in a patient with neurosyphilis.
abstract: BACKGROUND
  Bilateral simultaneous infarction in the territories of the posterior inferior cerebellar arteries (PICAs) is rare but was recently reported with increasing frequency, probably because of the wider availability of magnetic resonance imaging. The cause of these infarcts is believed to be atherosclerotic or embolic occlusion of a dominant PICA, which perfused the territories of the medial branches of both PICAs.
  
  
  RESULTS
  We encountered a patient with simultaneous infarction in the territories of the medial branches of both PICAs. The clinical course, imaging results, and laboratory findings are presented. The patient was diagnosed with neurosyphilis based on a history of chancre, positive serum and cerebrospinal serologies, cerebrospinal pleocytosis, and increased intrathecal immunoglobulin synthesis. We believe that meningovascular syphilis caused the bilateral cerebellar infarct via presumed thromboangiitis of a dominant PICA perfusing both cerebellar hemispheres. The patient was treated with intravenous high doses of penicillin.
  
  
  CONCLUSIONS
  This case reminds us that meningovascular syphilis should be considered in younger patients with stroke. Patients with bilateral cerebellar infarction may solely have symptoms of vertigo and ataxia but can develop life-threatening complications because of edema of the infarcted tissue with resultant hydrocephalus and pressure on the brainstem.
authors.affiliation: Department of Neurology, University of Arkansas College of Medicine, Little Rock, AR 72205, USA. umashankargopalan@uams.edu
authors.forename: Gopalan
authors.initials: G
authors.lastname: Umashankar
authors.forename: Vivek
authors.initials: V
authors.lastname: Gupta
authors.forename: Sami I
authors.initials: SI
authors.lastname: Harik
mesh_terms: D000328:Adult; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology*; D002531:Cerebellum / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009494:Neurosyphilis / Q000150:complications / Q000503:physiopathology*