How do you address incidental small cerebellar infarcts seen on MRI?

This is not an infrequent finding in outpatient neurology practice, often in the absence of any lacunar disease in the typical regions, though I usually see other evidence of small vessel disease. Are these infarcts attributable to small vessel disease or is evaluation for embolism typically indicated?

3 Answers

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Neurology · Vanderbilt University Medical Center

Answered on

I would obtain a CTA of the head and neck to look for vertebrobasilar disease. Probably too low yield to obtain an echocardiogram and Holter monitoring.

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Neurology · MarinHealth

Answered on

I generally do the whole stroke workup; CTA and referral to cardiology.

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Neurology · University of Colorado, Climate & Health Dept

Answered on

I handle it similarly to how I would approach a symptomatic stroke, but I tend to conduct the workup as an outpatient. The exception arises if it's an acute case (DWI positive) that seems embolic; in such instances, I opt for an expedited inpatient workup.

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