From the Guidelines
Infratentorial manifestations typically involve the cerebellum, brainstem, and cranial nerves, and can include symptoms such as ataxia, dysarthria, nystagmus, vertigo, vomiting, dysphagia, and various cranial nerve deficits, as well as altered consciousness due to brainstem compression 1.
Infratentorial Region
The infratentorial region contains critical structures that control balance, coordination, eye movements, and basic life functions such as breathing and heart rate regulation.
- Infratentorial lesions like tumors, strokes, or multiple sclerosis plaques in this area can be particularly dangerous due to the limited space available and proximity to vital centers.
- Early recognition of these manifestations is crucial as infratentorial pathologies can rapidly progress to life-threatening conditions due to potential brainstem compression or hydrocephalus from fourth ventricle obstruction.
Clinical Presentation
Common infratentorial manifestations include:
- Ataxia (uncoordinated movements)
- Dysarthria (slurred speech)
- Nystagmus (involuntary eye movements)
- Vertigo
- Vomiting
- Dysphagia (difficulty swallowing)
- Various cranial nerve deficits These symptoms occur because the infratentorial region contains critical structures that control balance, coordination, eye movements, and basic life functions.
Management
Patients with infratentorial location may benefit from availability of neurosurgical care, particularly in the setting of altered level of consciousness or new brainstem symptoms 1.
- Neurosurgical intervention can alter the clinical course for a subset of patients with ICH.
- The difficulty in interpreting these data is that the neurosurgical contribution to care is rarely isolated.
- One study included neurosurgical consultation in a care bundle with BP control and anticoagulation reversal and found a significant benefit on mortality 1.
Diagnostic Considerations
Infratentorial lesions can be diagnosed using magnetic resonance imaging (MRI), which can help identify the location and extent of the lesion.
- MRI can also help differentiate between different types of lesions, such as tumors, strokes, or multiple sclerosis plaques.
- The location and characteristics of the lesion can help guide management and treatment decisions 1.
From the Research
Infratentorial Manifestations
The infratentorial region, located below the tentorium cerebelli, can be affected by various conditions, leading to distinct manifestations. These include:
- Gangliogliomas: Infratentorial gangliogliomas can occur in the cerebellum and brainstem, with different imaging features and outcomes 2. Cerebellar gangliogliomas tend to be larger and have a higher cystic-solid ratio, while brainstem gangliogliomas are smaller and more solid.
- Intracerebral Hemorrhages: Infratentorial intracerebral hemorrhages can be divided into cerebellar and brainstem hemorrhages, with distinct presentations and outcomes 3. Brainstem hemorrhages tend to have worse severity of injury scores and poorer functional outcomes.
- Cognitive Dysfunction: Infratentorial strokes can lead to cognitive dysfunction, with similar rates of long-term cognitive impairment as supratentorial strokes 4.
- Empyema: Infratentorial empyema is a rare and life-threatening complication of bacterial meningitis, often presenting with subacute meningitis and delayed diagnosis 5.
- Spinocerebellar Ataxia Type 3: This condition is characterized by infratentorial damage, but also involves supratentorial regions, leading to a wide range of symptoms, including ataxia, Parkinsonism, and dysarthria 6.
Key Features
Some key features of infratentorial manifestations include:
- Imaging characteristics: Infratentorial lesions can have distinct imaging features, such as heterogeneous hyperintensity on T2WI and varying degrees of enhancement 2.
- Clinical presentation: Infratentorial conditions can present with a range of symptoms, including cerebellar findings, cranial nerve deficits, and cognitive dysfunction 3, 4, 5, 6.
- Outcomes: Infratentorial conditions can have varying outcomes, depending on the specific condition and location of the lesion 2, 3, 4, 5, 6.