Cerebellum, or Not Cerebellum, That Was the Question

Pontine infarction is a recognized subtype of posterior circulation stroke and can present with diverse clinical manifestations. It most frequently involves the anteromedial and anterolateral regions supplied by branches of the basilar artery. Clinical manifestations vary according to the anatomical boundaries of the affected perfusion territory and may present with an atypical constellation of signs and symptoms. We report an atypical case of acute left-sided upper pontine-pontomesencephalic infarction, presenting with severe sensory loss and cerebellar ataxia in a postmenopausal Indian female patient with a background of type 2 diabetes mellitus and hypertension. This case highlights that cerebellar features may manifest in the absence of a primary cerebellar lesion, particularly when such features are bilateral, emphasizing the importance of careful neuroanatomical localization.