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Global Ischemia of The Cerebellum: The Dark Cerebellar Sign


Cengiz Yılmaz,

Aksaray University Education and Research Hospital, TR
About Cengiz
Radiology department
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Ender Alkan ,

Aksaray University Education and Research Hospital, TR
About Ender
Radiology department
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Hasan Erdoğan

Aksaray University Education and Research Hospital, TR
About Hasan
Radiology department
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How to Cite: Yılmaz C, Alkan E, Erdoğan H. Global Ischemia of The Cerebellum: The Dark Cerebellar Sign. Journal of the Belgian Society of Radiology. 2019;103(1):19. DOI:
  Published on 11 Mar 2019
 Accepted on 17 Dec 2018            Submitted on 04 Dec 2018

Case History

A three-year-old boy with a history of motor vehicle accident presented with loss of consciousness. Non-enhanced cranial computed tomography (CT) (Figure 1) showed diffuse cerebellar hypodensity (open arrows) compared to supratentorial brain parenchyma (arrows). There was also a fracture dislocation of C1-C2 (Figure 2, arrow).

Figure 1 
Figure 2 


We want to present the dark cerebellar sign, which is not known as well as the white cerebellar sign. White cerebellar sign refers to a normal cerebellum and brainstem that appear hyperdense in comparison to the supratentorial brain on non-enhanced CT. The cerebellum and brainstem are believed to be more resistant to hypoxia-ischemia than the supratentorial brain [1]. A diffuse hypodensity of the cerebrum is seen in cases of profound and sustained hypoxia. This may occur in prolonged cardiac arrest, poisoning (carbon monoxide, cyanide, hydrogen sulfide, barbiturate), or as a complication of a severe meningo-encephalitis. On the other hand, the dark cerebellar sign is a much rarer finding and is characterized by a diffuse hypodense cerebellum compared to the normal density of the supratentorial brain parenchyma. The hypodensity of the cerebellum is caused by diffuse parenchymal cerebellar edema and/or infarction [2]. The prognosis is usually very poor. Acute cerebellitis should be in the differential diagnosis of a hypodense, edematous cerebellum [3]. At this situation clinical information may aid differential diagnosis.

In conclusion, dark cerebellar sign refers to diffuse hypodensity of the cerebellum at non-enhanced CT, and develops secondary to diffuse cerebellar ischemia/infarction. In our case diffuse cerebellar infarction probably developed secondary to transection of the vertebral artery.

Competing Interests

The authors have no competing interests to declare.


  1. Gean, AD. Imaging of Head Trauma. New York: Raven Press. 1994; 407–9. 

  2. Huisman, TAGM, Kubat, SH and Eckhardt, BP. The dark cerebellar sign. Neuropediatrics. 2007; 38: 160–3. DOI: 

  3. Sawaishi, Y and Takada, G. Acute cerebellitis. Cerebellum. 2002; 1: 223–8. DOI: 

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