Cortical and cerebellar hypometabolism after bilateral antero-inferior cerebellar artery infarct

A 55-year-old man with a history of hypertension, hypercholesterolemia, and tobacco use presented with sudden onset bilateral deafness, gait ataxia, and dysarthria. Clinical examination disclosed left-sided limb ataxia, bilateral gaze-evoked nystagmus, dysarthria, and bilateral hearing loss. Brain MRI showed a bilateral anterior inferior cerebellar artery (AICA) infarction (figure, A). Fluorodeoxyglucose PET scan ([18F] FDG PET) performed because of mild frontal syndrome (euphoria and decreased spontaneous activity) showed a mild cerebellar and prefrontal cortex hypometabolism (figure, B). He recovered after 1 month without sequelae. Five months later, he complained of apathy, poor motivation, and lack of interest in previous hobbies. Neuropsychological investigations disclosed a mild impairment of processing speed, alphabetic verbal fluency, attention and executive dysfunction such as difficulties in planning and disturbed mental flexibility; semantic and episodic memory and praxis were normal. An [18F] FDG PET control showed a severe bilateral cerebellar, frontal, temporal, and parietal hypometabolism (figure, …