Bilateral Dentate nuclei injury after global cerebral hypoperfusion: A case report

Objective: We report a case of bilateral dentate nuclei injury after global cerebral hypoperfusion. Background: Water zone infarcts in the cerebellum are usually seen at the borders of the anterior inferior cerebellar artery, superior cerebellar artery, posterior inferior cerebellar artery, and their branches. The dentate nucleus has been shown to be involved after hypoperfusion injury in a prior study using diffusion tensor imaging. To the authors’ knowledge, there are no case reports describing bilateral dentate nuclei lesions from global cerebral hypoperfusion injury. Design/Methods: A retrospective chart review was performed. A comprehensive review of the literature was performed on PubMed, Web of Science, MeSH, Google using keyword Cerebellum, hypoperfusion, hypoxia and Ischemia. Results: We present a 78-year-old black female with past medical history of Type 2 diabetes mellitus, hypertension, chronic kidney disease, heart failure with preserved ejection fraction, who was hospitalized after experiencing a fall resulting in open left tibial and femur fractures. The patient underwent operative repair of the fracture. Intra and the post-operative patient was noted to be hypotensive with systolic BP ranging 89–92 mm Hg and diastolic BP ranging 34–39 mm Hg. She was found to have persistent encephalopathy after the surgery. Neurologic examination demonstrated disorientation, dysarthria, 2/5 strength in right upper and lower extremities and 3/5 strength in left upper and lower extremities. NIHSS was 13. Magnetic resonance image suggested bilateral ACA/MCA territory waterzone infarction as well as ischemic changes in bilateral dentate nuclei in the cerebellum. MR angiogram head and neck did not show any large vessel stenosis or occlusion. Conclusions: Isolated bilateral dentate nuclei infarcts without other cerebellar lesions may be seen after global cerebral hypoperfusion. Disclosure: Dr. Shekhar has nothing to disclose. Dr. Gangadhara has nothing to disclose. Dr. Abuzeid has nothing to disclose. Dr. Nobleza has nothing to disclose. Dr. Sugg has nothing to disclose. Dr. Uschmann has nothing to disclose.