The Problem: Acute cerebellar infarcts are easy to see on diffusion imaging, but small chronic infarcts in the cerebellum are often missed because they are confused with normal cerebellar sulci. How do you differentiate small chronic cerebellar infracts from normal sulci?

The Answer:
In the Cerebellar Hemispheres:

Normal:

Chronic Infarct:

• Infarcts usually run perpendicular to the sulci
• If you see a CSF space running perpendicular to the sulcus its an infarct

 

 

In the Cerebellar Vermis:

Normal:

• Both sides of the vermis should be symmetrical on axial and coronal images.

 

Chronic Infarct:

• If its assymetric with parts of the vermis missing that is a sign of infarction.