Concurrent infarction in bilateral middle cerebellar peduncles: Rare presentation of stroke

Although some pathologies like demyelination have predilection for middle cerebellar peduncles (MCPs), infarction of bilateral MCP simultaneously is an exceedingly rare presentation of stroke. Patient was a 70-year-old smoker and hypertensive male presented with acute onset vertigo, imbalance while walking and slurred speech for 2 days and examination revealed horizontal nystagmus bilaterally, scanning speech with cerebellar signs and Modified Rankin Score (MRS) of 3. Magnetic resonance imaging brain showed symmetrical areas of diffusion restriction in both MCP, and there was occlusion of bilateral vertebral arteries (partial occlusion of right and complete occlusion of left) and basilar artery in computed tomography angiography. Oral antiplatelet with antihypertensive medication was started along with gait training and speech therapy. Patient had gradual and significant recovery and his MRS improved to 2 after 3 months' follow-up. Hypoperfusion along with atherothrombotic occlusion of vessels can be probable explanation to the bilateral infarction in MCPs which forms important watershed zone in posterior circulation of the brain