Territory of posterior inferior cerebellar artery (PICA)
Area arterie inferioris posterioris cerebelli
Definition
It is the most variable cerebral artery and has a variable territory depending on the size of the AICA. Typically, the PICA may supply:
- posteroinferior cerebellar hemispheres (up to the great horizontal fissure) : cerebellar tonsils, biventral lobule, nucleus gracilis, superior semilunar lobule, inferior portion of the vermis
- lower part of the medulla
Stroke pattern:
Common type of cerebellar stroke: headache, vertigo, nystagmus, ipsilateral axial lateropulsion, gait and appendicular ataxia.
More or less complete dorsal lateral medullary syndrome (Wallenberg syndrome) if the medulla is involved: ipsilesional vestibular (vertigo, vomiting, nystagmus, lateropulsion), V, IX and X cranial nerve palsies, Horner syndrome, appendicular ataxia with contralesional loss of pain and temperature sensation. Hiccups are frequent and prolonged.
References
The vascular territories in the cerebellum and brainstem: CT and MR study. by Savoiardo M, Bracchi M, Passerini A, Visciani A. AJNR Am J Neuroradiol. 1987 Mar-Apr;8(2):199-209.
Oxford Textbook of Stroke and Cerebrovascular Disease - Bo Norrving - Oxford University Press, 2014
