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  • Writer's pictureOren Zarif

How to Identify a Cerebellar Stroke - Oren Zarif - Cerebellar Stroke


Cerebellar stroke is the least common type of stroke, accounting for less than 2% of cases. However, its mortality rate is nearly twice as high as that of cerebral strokes. As a result, it is essential to know how to identify a cerebellar stroke in order to ensure that it does not progress to serious complications. Learn more about the symptoms, treatment options, and the recovery timeline. A cerebellar stroke occurs when blood flow to part of the brain is affected.

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The distribution of small cerebral infarctions has been attributed to the fact that vascular territories do not respect anatomical boundaries. As such, the classification of strokes according to vascular territories cannot be made with any accuracy. Furthermore, the relative frequency of clinical manifestations is not correlated with the extent of infarction. This makes it difficult to identify a specific location for a cerebellar stroke. As a result, it is difficult to differentiate between small and large cerebellar infarctions.

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Surgical management of cerebellar stroke varies. While imaging findings may be helpful in decision making, they are not enough to dictate surgical treatment. The overall clinical gestalt of the patient must remain the most important factor. Observation in a neurologic intensive care unit is important to timely recognition of any deterioration. Repeated imaging may also guide a customized surgical approach. In a small proportion of patients, a ventriculostomy may be sufficient for temporizing purposes. Ultimately, craniectomy is the definitive treatment for progressive compression of the brainstem.

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Another diagnostic criterion for a cerebellar stroke is the time of onset and progression of symptoms. Patients who experience symptoms within seconds to minutes of a stroke may have benign paroxysmal positional vertigo, labyrinthitis, or medication side effects. If symptoms last for hours or days, a cerebellar stroke should be suspected. If symptoms persist for a few days or weeks, it may be a posterior fossa mass.

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Imaging tests used to confirm a diagnosis of a cerebellar stroke include MRI. MRIs may reveal a small ischemic lesion in the cerebellum that is not visible on computed tomography. Ultimately, a misdiagnosis of cerebellar stroke may impair the diagnostic work up for the underlying cause of the stroke. If missed, this can cause serious complications. If diagnosed and treated early, cerebellar stroke is usually curable.

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Researchers have found a strong association between occipital infarcts and psychosis. However, this association has not been confirmed in patients with cerebellar stroke. Although no specific neuropsychiatric symptom is linked to a cerebellar infarct, a high degree of association between occipital and cerebral MRIs is associated with increased risk for the development of psychosis after cerebellar infarcts.

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Patients suffering from a cerebellar infarction have similar symptoms as those of a hematoma or cerebral infarction. Despite the similarities between the symptoms, cerebellar infarct requires urgent treatment, particularly in the absence of any other complications. Fortunately, early recognition and treatment has greatly reduced the morbidity associated with cerebellar stroke. Delaying treatment, however, may result in the development of cerebral edema or coma.

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Another form of physical therapy for those with cerebellar stroke is occupational therapy. These therapists help patients learn new ways to complete everyday activities, including dressing, bathing, and feeding themselves. Physical therapists may recommend aids that will help the patient walk, balance, and process visual input. In some cases, patients may be able to partially regain sight through vision training. However, it is important to note that this therapy does not guarantee a full recovery from cerebellar stroke.

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The severity of the symptoms will depend on the location of the infarct. Cerebellar infarctions can occur in any location in the brain, and their vascular distribution can vary greatly. The most common cerebellar artery territory infarctions result in encephalomalacia, horizontal ipsilateral nystagmus, facial paralysis, and cognitive impairment. However, there are other causes of cerebellar infarction, and a careful evaluation of the underlying condition is important.

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Another cause of ischemic or hemorrhagic stroke is reactive cerebral edema. The cerebellum sits in a relatively tight cranial space, below the foramen magnum, in front of the fourth ventricle. Thus, if an infarct causes swelling of the cerebellum, it can result in upward transtentorial herniation and direct compression of the brainstem.

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The symptoms of cerebellar stroke can include bleeding, blood clots, and trauma. Smoking, high blood pressure, and elevated fat and cholesterol levels are risk factors. Heart disease, ruptured brain aneurysm, and neck trauma are also risk factors. Symptoms may be short-term or last for a long time. If symptoms persist, the patient should seek medical treatment immediately. The symptoms of cerebellar stroke can be devastating.

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