Unilateral Cerebellar and Brain Stem Hypoplasia in a Child with a Postnatal Diagnosis of Dissecting Aneurysm in Basilar Artery

Abstract

Cerebellum is highly vulnerable in the prenatal period. Increasing experience with fetal imaging studies has demonstrated that unilateral cerebellar hypoplasia (UCH) is mainly prenatally acquired, representing disruption rather than a true malformation. Here, we report the case of a 17-month-old boy presented with a sudden onset of abnormal eye movements, who was diagnosed during routine fetal screening with UCH and brain stem hypoplasia and suffered from cerebral palsy; however, no posterior arterial system pathology was detected on cranial magnetic resonance images at that time. Following this acute event, diagnostic neuroradiological interventions revealed a dissecting aneurysm with a saccular component in midbasilar arterial segment and hypoplastic left posterior cerebral artery, which may support the ischemic disruptive mechanism in the development of prenatally detected UCH in this child. The pathogenetic mechanisms for cerebellar disruption are certainly multifactorial in origin, although ischemic arterial etiologies were often undervalued.

Keywords

unilateral cerebellar hypoplasia - cerebellar disruption - prenatal disruptive etiologies - ischemic stroke in early childhood - childhood aneurysms of posterior cerebral circulation

• References

• 1 Messerschmidt A, Brugger PC, Boltshauser E , et al. Disruption of cerebellar development: potential complication of extreme prematurity. AJNR Am J Neuroradiol 2005; 26 (7) 1659-1667
• 2 Sidman RL, Rakic P. Neuronal migration, with special reference to developing human brain: a review. Brain Res 1973; 62 (1) 1-35
• 3 Poretti A, Prayer D, Boltshauser E. Morphological spectrum of prenatal cerebellar disruptions. Eur J Paediatr Neurol 2009; 13 (5) 397-407
• 4 Salman MS, Maria BL. Brainstem and cerebellar malformations. In: Maria BL, ed. Current Management in Child Neurology. London: BC Decker Incorporated; 2005
• 5 Benbir G, Kara S, Yalcinkaya BC , et al. Unilateral cerebellar hypoplasia with different clinical features. Cerebellum 2011; 10 (1) 49-60
• 6 Lee J, Croen LA, Backstrand KH , et al. Maternal and infant characteristics associated with perinatal arterial stroke in the infant. JAMA 2005; 293 (6) 723-729
• 7 Limperopoulos C, Robertson RL, Sullivan NR, Bassan H, du Plessis AJ. Cerebellar injury in term infants: clinical characteristics, magnetic resonance imaging findings, and outcome. Pediatr Neurol 2009; 41 (1) 1-8
• 8 Robins JB, Mason GC, Watters J, Martinez D. Case report: cerebellar hemi-hypoplasia. Prenat Diagn 1998; 18 (2) 173-177
• 9 Bodensteiner JB, Johnsen SD. Cerebellar injury in the extremely premature infant: newly recognized but relatively common outcome. J Child Neurol 2005; 20 (2) 139-142
• 10 Limperopoulos C, Benson CB, Bassan H , et al. Cerebellar hemorrhage in the preterm infant: ultrasonographic findings and risk factors. Pediatrics 2005; 116 (3) 717-724
• 11 Lerner A, Gilboa Y, Gerad L, Malinger G, Kidron D, Achiron R. Sonographic detection of fetal cerebellar cavernous hemangioma with in-utero hemorrhage leading to cerebellar hemihypoplasia. Ultrasound Obstet Gynecol 2006; 28 (7) 968-971
• 12 Malinger G, Zahalka N, Kidron D, Ben-Sira L, Lev D, Lerman-Sagie T. Fatal outcome following foetal cerebellar haemorrhage associated with placental thrombosis. Eur J Paediatr Neurol 2006; 10 (2) 93-96
• 13 Kocak B, Tureci E, Kizilkilic O, Islak C, Kocer N. Dissecting aneurysms of posterior communicating artery itself: anatomical, diagnostic, clinical, and therapeutical considerations. Neuroradiology 2013; 55 (9) 1103-1112
• 14 Lasjaunias P, Wuppalapati S, Alvarez H, Rodesch G, Ozanne A. Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 2005; 21 (6) 437-450
• 15 Mackay MT, Prabhu SP, Coleman L. Childhood posterior circulation arterial ischemic stroke. Stroke 2010; 41 (10) 2201-2209