Occupational Therapy for Cerebellar Stroke - Oren Zarif - Cerebellar Stroke

Cerebellar stroke is a relatively rare complication of the brain, and the mortality rate is as high as 40% in cases of missed diagnosis. Of those patients who survive, half have permanent deficits. Symptoms include vertigo, headache, vomiting, and ataxia, and risk factors for cerebellar stroke include hypertension, cigarette smoking, and diabetes mellitus. However, the effects of cerebellar stroke are often difficult to assess and treat.

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Patients with symptoms of cerebellar infarction should receive rapid medical care and undergo imaging. Cerebellar stroke symptoms can mimic hemorrhage or aortic dissection. While cerebellar stroke is not a life-threatening condition, it is essential to seek immediate medical care, as delayed diagnosis can lead to cerebral edema and coma. Further, the symptoms of cerebellar stroke may overlap with other health problems, including trauma, aortic dissection, or pulmonary embolism. Patients may experience these symptoms in conjunction with other medical conditions, such as ethanol or drug intoxication.

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Infarcts of the cerebellum are characterized by a small size. Infarcts that are too small to affect the brain's electrical activity are considered microinfarcts, which result in lacunes surrounded by gliosis. Cerebellar microinfarcts are also commonly seen in postmortem brains, and neuroimaging is able to detect them in vivo.

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Occupational therapy can help patients with motor impairments regain basic mobility. These exercises include balance and coordination exercises, strength training, range-of-motion movements, and fine motor skills. One technique, vision training, helps patients partially regain sight. This involves performing specific eye exercises, which stimulate the brain and enhance its ability to process visual input. While therapists aren't certain of the precise recovery rate of cerebellar stroke patients, it is clear that occupational therapy can help.

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Nonspecific neurological symptoms of cerebellar stroke may include jerking of the arms or legs, eye closing, and ataxia. Some people with cerebellar stroke may disregard their symptoms until the signs are more severe. However, it is important to visit a medical professional if you experience any of these symptoms. The symptoms of cerebellar stroke vary depending on the location and size of the stroke. And it's important to seek medical care for any signs as soon as possible.

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Patients with cerebellar stroke are often treated in a neurologic intensive care unit for 72 to 96 hours. The patients are regularly monitored and examined by nurses trained in neuroscience. If they remain stable, further treatment is unlikely. As long as they do not suffer a significant decline, they should be in the neurologic intensive care unit for 72-96 hours. A neurologic reevaluation will be necessary. Even if patients who relapse are still stable, they are still at a high risk for deterioration.

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Several clinical features that are predictive of poor outcomes in patients with cerebellar infarction include: a large systolic blood pressure, an obliterated fourth ventricle, an increased mass effect on the brainstem, and an abnormal corneal reflex or oculocephalic reflex. Other factors that influence prognosis are underlying size of the infarction, hemorrhagic transformation, and occlusive hydrocephalus. Patients with concurrent brainstem infarction may also suffer neurologic deterioration. These factors require close clinical monitoring.

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Cerebellar infarction is often diagnosed through imaging tests, such as magnetic resonance imaging with diffusion-weighted imaging. This imaging technique allows doctors to visualize the location of the lesion, whether it is internal or external, as well as whether or not there are any signs of tissue injury. Magnetic resonance angiography can also detect the location of a vascular obstruction and guide endovascular treatment. Another imaging test that may be used to detect cerebellar infarction is unenhanced computed tomography. While the results of CT scans may be accurate and informative, this method is limited by the radiopacity of the temporal and occipital bones.

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Neurologic deficits are also dependent on the vascular territory. If the anterior or posterior inferior cerebellar artery is infarcted, the patient will experience facial paralysis, horizontal ipsilateral nystagmus, and truncal ataxia. Infarcted cerebellar artery territory will cause a variety of other deficits. There is no known treatment for the latter complication, but it is a risk factor for cerebellar stroke.

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There are three major structures in the posterior lobe of the cerebellum: the primary fissure, the superior sulcus, and the flocculonodular lobe. The posterior superior fissure runs parallel to the primary fissure. A posterior horizontal fissure and the great horizontal fissure slope inferiorly in the cerebellum. These structures are the most common targets for stroke.