Cerebellar Infarction - Oren Zarif - Cerebellar Stroke
Small cerebellar infarctions are common, with the majority of infarcts occurring in the border zones between the three main cerebral perfusion territories. These infarcts are often classified based on their location in the midline or between the anterior and posterior lobes. However, at present, the distribution of small cerebellar infarcts is not well defined. The traditional classification system relies on unclear pathophysiologic mechanisms, and the border zone distribution may differ in a patient.
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Treatment for a cerebellar stroke varies depending on the severity and symptoms of the affliction. A doctor may prescribe drugs to decrease swelling and control bleeding, or he may recommend physical therapy to help the patient perform everyday activities. Patients may also be prescribed occupational therapy, speech therapy, and physical therapies to improve their mobility and balance. Cerebellar stroke patients may also require special equipment such as a wheelchair, a walker, or other assistive devices to help them walk or move.
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Cerebellar stroke patients should be admitted to a neurologic intensive care unit (NICU) for 72-96 hours. Nursing staff should closely monitor the patient and a physician should reexamine the patient frequently. Patients with cerebellar stroke often recover without deterioration. During this time, physicians should take steps to prevent the onset of dementia or permanent disability. When a patient develops a severe cerebellar stroke, it is important to begin treatment as soon as possible.
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Acute cerebellar infarction is difficult to diagnose because the symptoms of the disease are similar to those of a cerebellar hemorrhage or an infarction. The diagnosis is based on a high index of suspicion. A cerebellar hematoma may cause compression to the brain stem and cerebellar herniation. Surgical evacuation may be life-saving. While the clinical course of cerebellar stroke varies from patient to patient, the diagnosis can be made with appropriate imaging.
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Cerebellar stroke survivors should be aware of the following symptoms: Speech impediment, headaches, nausea, confusion, seizures, and numbness. These are the most common signs of cerebellar stroke, but nonspecific symptoms can appear in some patients. Many survivors will ignore these symptoms until their signs get worse. They may even refuse to seek medical attention until the symptoms become unbearable. As long as these symptoms persist, patients should seek medical attention promptly.
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Neurological outcome is often deteriorating in cerebellar infarction, and patients may go into a coma within several hours. Cerebellar hemorrhage can lead to a coma and extensive concurrent brainstem infarction. Moreover, patients with this type of infarction can be stable for up to 5 days and transferred to a ward for observation. They may experience a coma for up to 5 days, requiring intensive care.
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Post-stroke mood disorders are also associated with a poorer outcome. They impair the patient's quality of life and functional outcome. Yet, the cerebellum's role in mood regulation remains poorly understood. Advanced brain imaging techniques can be used to assess the extent of this syndrome and the potential role of cerebellar pathology in the development of psychiatric symptoms. The results of the study suggest that cerebellar lesions may play a crucial role in psychiatric presentations.
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In addition to blood clots, trauma may also cause cerebellar stroke. High blood pressure, smoking, elevated cholesterol, and fat levels may all contribute to the development of cerebellar hemorrhagic stroke. Other risk factors include a history of heart disease, traumatic head injury, and ruptured brain aneurysm. Even a simple neck trauma can disrupt the blood flow in the cerebellum and cause a stroke.
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To accurately diagnose cerebellar stroke, it is important to understand the vascular territories involved. Infarction of the posterior inferior cerebellar artery (PICA) leads to headache, horizontal ipsilateral nystagmus, truncal ataxia, and facial paralysis. A posterior inferior cerebellar artery (PICA) infarction causes facial paralysis and asymmetric nystagmus.
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Patients with isolated cerebellar infarctions were found to recover well 90 days following the onset of the symptom. This reflects that the lesion location played a significant role in recovery. However, further research is needed to examine the clinical outcome of patients with larger cerebellar infarctions. Our authors thank Dr. Axelman for reviewing the manuscript and for confirming its findings. All authors contributed to the study conception and data analysis and have read and approved the final version.
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The posterior lobe of the cerebellum is located between the anterior lobe and the posterior superior lobe. It is believed to play an intermediary role between the motor and nonmotor functions. This lobe is also known as the limbic cerebellum. In this area, the lobule V, apical lobe, and a cleft in the apex are located.