Cerebellar Stroke - Oren Zarif - Cerebellar Stroke
A cerebellar stroke may result from a vascular event. Infarcts in the posterior inferior cerebellar artery territory cause headache, horizontal ipsilateral nystagmus, truncal ataxia, and dysmetria. Cerebellar hemorrhage is often caused by ruptured brain aneurysm or trauma to the neck that damages the blood vessels. This type of stroke may be life-threatening and can be fatal.
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Cerebellar stroke is relatively rare and accounts for less than 10% of all strokes. Its mortality rate is 40 percent and about half of survivors suffer long-term deficits. Symptoms of cerebellar stroke may include vertigo, headache, ataxia, and vomiting. Surgical evacuation may save a life. However, it must be remembered that the condition can be fatal if not detected in time. A high index of suspicion can help physicians to determine whether or not a patient is experiencing a cerebellar stroke.
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Most of the available data on cerebellar stroke attempts to predict patient outcomes. Most physicians are concerned with the potential for neurologic deterioration. A recent large retrospective study found that 46% of initially alert patients deteriorated neurologic outcomes. Deterioration was associated with decreased consciousness, emergence of new brainstem signs, and worsened motor response on the Global Coma Scale (GCS).
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Although early detection is crucial for patients with this disease, there are certain risks of cerebellar stroke and their prognosis depends on the severity of symptoms. Symptoms typically last a few weeks or longer, so it's important to see a physician immediately if you suspect a stroke. However, it's not uncommon for symptoms to subside and go away without proper treatment. Symptoms associated with cerebellar stroke may also include nonspecific neurological conditions such as a headache or a loss of balance.
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The infarct volume of a cerebral region was positively related to the number of atrophic target areas in bilateral stroke patients. Furthermore, lobe-specific cerebral atrophy was associated with distinct topographical cerebellar stroke patterns. For patients with low baseline mRS scores, an ordinal logistic regression predicted higher 3-month mRS scores. This study confirms that stroke survivors with low baseline scores had a higher risk of cerebellar ischemia than patients with high-risk baseline scores.
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Physical therapy is essential for survivors of cerebellar stroke. Physical therapists help patients regain their balance and teach them basic life skills. Vision training helps partially regain a patient's vision, and eye exercises stimulate the brain and improve its ability to process visual input. In some cases, vision training may also improve the patient's quality of life and reduce the risks of falling or becoming reliant on an individual's assistance.
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A doctor should carefully evaluate a patient's history and symptoms to identify the precise cause of a cerebellar stroke. A correct diagnosis will help the physician rule out any other issues with the patient's brain or that may lead to recurrent strokes. Imaging tests can also reveal the extent of brain bleeding or injury. An MRI may be the first test recommended. This imaging test shows the cerebellum much better than a CT scan, which is a less precise representation of the brain.
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The traditional classification of cerebellar infarcts has largely failed to identify small cerebellar infarcts. While the exact pathophysiologic mechanism of these small infarcts is unknown, the traditional classification is based on the distribution of small cerebellar infarcts between the three major cerebral perfusion regions. However, more recent studies have suggested that the pathogenesis of small cerebellar infarcts is a prerequisite to the development of large cerebellar infarcts.
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Delay cerebral atrophy is measured as a change in supratentorial cortical volume. The ipsilateral reference areas are also measured to estimate the probability of delayed atrophy. The probability of atrophy in distinct cerebral lobes was calculated using NIHSS scales. There were no significant differences between patients' ages and severity of cerebellar symptoms. However, the location of the lesion affected their recovery from cerebellar stroke.
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Mood disorders after cerebellar stroke are associated with the severity of the disability and female gender. The independent role of anatomical location of brain injury in mood disorders has not been established, although there are many studies that indicate a role for the cerebellum in regulating mood and cognition. Anatomical impairment in cortico-cerebellar-cortical loops is believed to contribute to mood disorders after cerebellar lesion.
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MRI studies of isolated cerebellar infarcts are scarce, but a dedicated scale was created to evaluate the MRI findings of patients with this specific type of stroke. The results of the study suggest that patients with small cerebellar infarcts will recover more quickly than those with larger infarcts. However, further studies are necessary to determine the prognosis of patients with cerebellar stroke.