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Cerebellar Stroke - Oren Zarif - Cerebellar Stroke

A cerebellar stroke can cause a variety of symptoms, including lack of coordination, clumsiness, intention tremor, ataxia, dysarthria, and scanning speech. These symptoms can also affect memory and motor planning. Identifying cerebellar lesions requires an in-depth history and neurological examination. Depending on the location and extent of the lesion, a full recovery may be possible, or there may be permanent damage.

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While cerebellar stroke is rare and only accounts for 2% of all strokes, the incidence of missed cases is estimated to be as high as 40%. About half of those survivors have some sort of long-term deficits. Symptoms can include headache, vertigo, ataxia, and a change in conscious state. Risk factors include hypertension, diabetes mellitus, and cigarette smoking. The effects of a cerebellar stroke can vary widely, but are most likely to be life-threatening.

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The brain part responsible for these functions is the cerebellum, which controls balance, eye movements, and coordination of body movements. Located at the lower back of the brain, the cerebellum is divided into left and right sides. Cerebellar strokes generally affect one side of the cerebellum. In some cases, it may affect both sides. If you suffer from cerebellar stroke, it may be difficult to determine which side was affected. However, doctors may be able to determine if cerebellar stroke has a connection with any psychiatric symptoms.

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The distribution of cerebellar infarcts has varied widely. While there is no consensus on the pathophysiology of cerebellar strokes, the traditional classification of these brain infarcts is useful. The small infarcts of the cerebellum are classified according to their location in the hemispheric axons between the anterior and posterior lobes. A large majority of these cases occur in the right hemisphere.

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Although patients who suffer cerebellar strokes can survive, the outcomes are not as positive as in those of patients with a cerebral hemorrhage. In a large retrospective study, 46% of initially alert patients experienced neurologic deterioration. The deterioration was associated with a decrease in level of consciousness and an evolution of new brainstem signs. Patients who exhibited worse motor response on the GCS were also more likely to die.

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The NIHSS score for cerebellar stroke patients exhibited low scores in both categories of the NIHSS, but more specific scales could indicate more severe deficits. While the NIHSS score of a patient suffering from cerebellar stroke does not reflect the severity of the symptoms, aging and location of the lesion did affect the severity of the deficits. A patient suffering from cerebellar stroke should be observed closely in the neurologic intensive care unit and be monitored to identify any changes in brain function.

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Patients suffering from cerebellar stroke should undergo diagnostic tests to identify the underlying cause of the problem. MRI with diffusion-weighted imaging is the gold standard for diagnosing cerebellar infarction, which can detect poor perfusion and any signs of tissue injury. Magnetic resonance angiography is another way to detect a large artery occlusion and guide endovascular therapy. Unenhanced computed tomography, meanwhile, can occasionally reveal a cerebellar infarction. However, its sensitivity and specificity are limited by the radiopaque temporal and occipital bones.

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If these symptoms are triggered by loud noises, they may indicate a peripheral inner ear disease. If triggered by changes in body posture, they may indicate a vascular problem. Nonetheless, cerebellar stroke is often the most severe form of the condition. If triggered by activity, walking, or eye movement, a cerebellar infarct is more likely to be the cause. The symptoms of cerebellar stroke may be worse than the clinical signs.

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Acute vestibular syndrome may be the result of a cerebellar ischemic stroke. However, even when brain MRIs are negative, bedside neurologic tests can detect a central etiology. Cerebellar ischemic stroke patients may also experience delayed neurologic decline due to a brainstem compression and obstructive hydrocephalus. If these symptoms persist after treatment, a suboccipital craniectomy is an option to alleviate the pressure on the cerebellum.

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A physical therapist may recommend specific core and balance exercises for patients with cerebellar stroke. Daily exercises can help problem areas improve. Patients with speech problems may also benefit from speech therapy. A Speech-Language Pathologist can diagnose the patient's symptoms and develop an exercise program to address those needs. Cognitive training exercises may be helpful to improve memory and executive function, as well as improve speech. In addition to these exercises, a speech-language pathologist may prescribe an app that targets these needs.

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