Cerebellar Stroke - Oren Zarif - Cerebellar Stroke

Cerebellar stroke is a less common type of stroke that occurs when a blood vessel becomes blocked or bleeding causes disruption of the cerebellum. This type of stroke usually affects one side of the brain, and is also known as cerebellar stroke syndrome. The cerebellum is a part of the brain that controls balance, coordination of body movements, and eye movement. The cerebellum is located at the back of the brain, and is symmetric, with a left and right side. Each side of the cerebellum controls movement on the opposite side of the body.

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Small cerebellar infarcts were first identified on postmortem pathology studies. These lesions were initially referred to as lacunar infarcts. Despite their small size, they had no clinical correlation and remained undiagnosed until the advent of CT scans. This era, however, has helped us develop a reliable classification system based on cerebellar topography. Currently, we have a few distinct classifications for cerebellar infarcts.

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After a cerebellar stroke, speech and physical therapy may be recommended to improve patients' ability to speak and move. Occupational therapy, helps people with severe neurological damage regain basic life skills. Vision training, on the other hand, may help some patients regain some sight. Vision training involves specific exercises to stimulate the brain and improve the way the eyes process visual input. This type of treatment is effective for people with a cerebellar stroke, but experts still do not know exactly how much recovery a patient will make.

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Treatment for cerebellar stroke is not always straightforward and may include a combination of medical and surgical interventions. While imaging findings can assist in the clinical decision-making process, they cannot decide whether or not to undertake aggressive surgical management. The overall clinical gestalt of the patient must always be considered first. Repeated imaging may help determine the appropriate surgical approach, or alternatively, the patient may only require a ventriculostomy to alleviate their symptoms.

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Unlike other types of stroke, symptoms for cerebellar stroke may be non-specific and difficult to diagnose. A thorough history and a neurological exam are essential to determine the exact location and extent of the lesion. This is important because delayed treatment can lead to long-term or permanent damage. If you are concerned about a child experiencing a cerebellar stroke, make sure to seek immediate medical attention. Your doctor will be able to help your child live a full life and avoid the risk of a stroke.

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In some cerebellar stroke cases, reactive cerebral edema can be problematic. The cerebellum occupies a small cranial space in the posterior cranial fossa, between the tentorium cerebelli and the occipital bone. This area of the brain is relatively close to the fourth ventricle, and swelling can cause it to herniate upward. Moreover, the swelling may interfere with the fourth ventricle, resulting in direct brainstem compression.

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A recent retrospective study has identified some characteristics that may help physicians predict patient outcomes. Most cerebellar stroke data, however, attempt to predict the outcome. Neurologic deterioration is the chief concern of physicians. In the same study, 46% of initially alert patients deteriorated neurologicly. These patients showed a decline in consciousness and a worsened motor response on the Glasgow Coma Scale (GCS).

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Patients with cerebellar stroke often exhibit nonspecific symptoms that overlap with other medical conditions. In addition to stroke, cerebellar hemorrhage and infarction may have similar symptoms. Moreover, early recognition and treatment of cerebellar stroke have decreased morbidity. A delayed diagnosis and treatment could lead to cerebral edema and ultimately to the patient's death. Cerebellar infarction is often associated with symptoms of pulmonary embolism, hypoglycemic disease, and pneumonia.

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MRI shows that a small acute infarct has formed between the two lobes of the cerebellum. This infarct is situated in the posterior lobe, lobule VI. An MR angiogram reveals that both the proximal basilar artery and the distal left vertebral artery are obstructed. In axial T2WI, multiple chronic infarcts are noted on the left cerebellar hemisphere, and one similar infarct is found on the right side. Both of these infarcts are located beneath the primary fissure.

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Cerebellar infarcts can be very small, measuring less than 2 cm. Previously, these were referred to as lacunar infarcts based on neuropathological findings. Because of the confusion caused by these terms, the pathogenesis and diagnosis of cerebellar infarcts is poorly understood. Consequently, the following terminology was introduced to help make the diagnosis easier. There is no consensus on the most appropriate diagnosis and treatment of cerebellar infarcts.