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Pontocerebellar Atrophy Resembling Spinocerebellar Ataxia
Following a Brain Infarction
Masayuki Ueda and Yasuo Katayama
Key words: brain infarction, multiple system atrophy, magnetic resonance imaging
(Intern Med 52: 933-934, 2013)
(DOI: 10.2169/internalmedicine.52.9459)

Picture.

A 62-year-old man complained of gait disturbance associated with mild ataxia. Brain T2-weighted MR imaging revealed pontocerebellar atrophy with middle cerebellar
peduncle (MCP) atrophy, thus suggesting the presence of a
degenerative disorder (Picture A). However, the patient had
a history of ischemic stroke at 56 years of age. His initial
symptom of bilateral deafness improved thereafter, as has
been described elsewhere (1). Diffusion-weighted imaging
obtained on admission revealed bilateral MCP and cerebellar
acute infarctions (Picture B); however, no pontocerebellar at-

rophy was observed on T2-weighted imaging (Picture C). CT
angiography disclosed narrow bilateral anterior inferior cerebellar arteries (AICAs) and calcified bilateral vertebral arteries (Picture D).
MCP infarctions are caused by AICA territory ischemia,
although the lesions are usually unilateral. Pontocerebellar
atrophy with bilateral MCP atrophy is a characteristic MR
finding of multiple system atrophy, a sporadic degenerative
spinocerebellar ataxia (2). Bilateral MCP infarctions are
rare; however, poststroke tissue loss can result in pontocere-

Department of Neurology, Nippon Medical School, Japan
Received for publication December 5, 2012; Accepted for publication January 7, 2013
Correspondence to Dr. Masayuki Ueda, ueda@nms.ac.jp

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Intern Med 52: 933-934, 2013

DOI: 10.2169/internalmedicine.52.9459

bellar atrophy, which may resemble degenerative spinocerebellar ataxia.

References

The authors state that they have no Conflict of Interest (COI).

1. Sunami E, Nagayama H, Yamazaki M, Katsumata T, Katayama Y.
A case of infarction in brainstem and cerebellum as a initial
symptom with bilateral hearing loss. No To Shinkei 58: 791-795,
2006 (in Japanese).
2. Bürk K, Bühring U, Schulz JB, Zühlke C, Hellenbroich Y,
Dichgans J. Clinical and magnetic resonance imaging characteristics of sporadic cerebellar ataxia. Arch Neurol 62: 981-985, 2005.

Ⓒ 2013 The Japanese Society of Internal Medicine
http://www.naika.or.jp/imonline/index.html

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