A 67-year-old man had the sudden onset of vertigo, gait unsteadiness, and vomiting. A week prior to these symptoms, he had developed transient left leg weakness lasting 10 minutes. At presentation, his examination showed a wide-based, unsteady gait with right-sided lateropulsion. Magnetic resonance imaging of the brain showed an acute infarction involving the right posterior inferior portion of the cerebellum (Figure 1). Magnetic resonance angiography of the brain showed no intracranial stenoses. Transthoracic echocardiogram revealed no embolic source. Computed tomography angiography of the neck showed an intraluminal thrombus at the right vertebral artery origin (Figure 2A) that was no longer seen after 3 months of anticoagulation with warfarin sodium (Figure 2B). The patient's vertigo and gait instability had completely resolved on follow-up at 3 months.
Searls DE, Caplan LR, Safdar A, Kumar S. Vertebral Artery Origin Thrombus in a Patient With Cerebellar Infarct. Arch Neurol. 2008;65(10):1386-1387. doi:10.1001/archneur.65.10.1386