Erroneous resection of a cerebellar infarction – Lesson learned

We describe the clinical process and treatment details in a noteworthy case with a cerebellar lesion which achieved a satisfactory clinical course. A 64-year-old female presented with nausea and vomiting. The patient had exhibited progressive gait disturbance for several days. Magnetic resonance (MR) imaging disclosed a mass, which was low-intense on T1 weighted imaging, high-intense on T2 weighted imaging, and low-intense on diffusion weighted imaging, in the left cerebellar hemisphere. The clinical symptoms rapidly deteriorated within a few days and the lesion extended to the cerebellar peduncle and brain stem with a contrast enhancement effect on part of the margin. Since the onset and transition of the symptoms were inconsistent with the course of an infarction, the patient underwent resection surgery in view of the possibility of cerebellar glioma, including glioblastoma. The lesion was removed as much as possible and her clinical symptoms became significantly improved. Post-operative MR imaging revealed that a T2 high-intense area remained in the cerebellar peduncle and brain stem. Since a neoplastic lesion was strongly suspected from the imaging findings, chemoradiation therapy was planned. However, we failed to find tumor cells in resected samples, although the material was sufficiently large to discount sampling error. We finally diagnosed it for cerebellar infarction. The lesion did not undergo change thereafter, and no recurrence or progression was observed at 6 months after the operation. Sufficient lesion resection with decompression proved effective in the present case, as we continued to suffer difficulty in reaching an accurate pathological diagnosis for the lesion in the cerebellum. Accurate diagnosis with various studies and flexible selection of treatment strategy are considered to be crucial in for the treatment of cerebellar lesions.