Cerebellar stroke: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*5 Ds of Posterior Circulation Stroke: Dizziness, Dysarthria, Dystaxia, Diplopia, Dysphagia | *5 Ds of Posterior Circulation Stroke: Dizziness (Vertigo), Dysarthria, Dystaxia, Diplopia, Dysphagia | ||
*Sudden inability to walk is common finding | *Sudden inability to walk is common finding | ||
*Can be confused w/ acute vestibular syndrome (e.g. labyrinthitis) | *Can be confused w/ acute vestibular syndrome (e.g. labyrinthitis) | ||
| Line 17: | Line 17: | ||
***Bad nystagums beats in every direction their eyes look | ***Bad nystagums beats in every direction their eyes look | ||
****If pt looks left, get left nystagmus, if looks right, get right-beating nystagmus | ****If pt looks left, get left nystagmus, if looks right, get right-beating nystagmus | ||
***Peripheral vs Central [[Nystagmus]]<sup>1</sup> | |||
**3. Test of Skew | **3. Test of Skew | ||
***Vertical dysconjugate gaze is bad | ***Vertical dysconjugate gaze is bad | ||
| Line 44: | Line 45: | ||
*See [[Stroke (Main)]] | *See [[Stroke (Main)]] | ||
*See [[Thrombolysis in Acute Ischemic Stroke (tPA)]] | *See [[Thrombolysis in Acute Ischemic Stroke (tPA)]] | ||
==Source== | |||
#Lewandowski C, Santhakumar S. Posterior Circulation Stroke. Foundation for Education and Research in Neurologic Emergencies (FERNE). Review Article. | |||
==See Also== | ==See Also== | ||
*[[Stroke syndromes]] | *[[Stroke syndromes]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 05:44, 18 July 2014
Clinical Features
- 5 Ds of Posterior Circulation Stroke: Dizziness (Vertigo), Dysarthria, Dystaxia, Diplopia, Dysphagia
- Sudden inability to walk is common finding
- Can be confused w/ acute vestibular syndrome (e.g. labyrinthitis)
Exam
- HINTS Exam can reliably distinguish the two (more effective than early DWI MRI)
- 1. Head Impulse Testing
- Tests vestibulo-ocular reflex
- Have pt fix their eyes on your nose
- Move their head in the horizontal plane to the left and right
- If reflex is intact their eyes will stay fixed on your nose
- If reflex is abnormal eyes will move with their head and won't stay fixed on your nose
- It is reassuring if the reflex is abnormal!(due to dysfunction of the nerve)
- 2. Nystagmus
- Benign nystagmus only beats in one direction no matter which direction their eyes look
- Bad nystagums beats in every direction their eyes look
- If pt looks left, get left nystagmus, if looks right, get right-beating nystagmus
- Peripheral vs Central Nystagmus1
- 3. Test of Skew
- Vertical dysconjugate gaze is bad
- Alternating cover test
- Have pt look at your nose w/ their eyes and then cover one eye
- When rapidly uncover the eye look to see if the eye quickly moves to re-align
- Have pt look at your nose w/ their eyes and then cover one eye
- If any of the above 3 tests are consistent w/ CVA obtain full work-up (including MRI)
- 1. Head Impulse Testing
Work-Up
- Bedside glucose
- Bedside Hb (polycythemia)
- CBC
- Chemistry
- Coags
- Troponin
- ECG (esp A-fib)
- Head CT
- Primarily used to exclude intracranial bleeding, abscess, tumor, other stroke mimics
- Also consider:
- Pregnancy test
- CXR (if infection suspected)
- UA (if infection suspected)
- Utox (if ingestion suspected
Treatment
- Early neurosurgical consultation is needed (herniation may lead to rapid deterioration)
- See Stroke (Main)
- See Thrombolysis in Acute Ischemic Stroke (tPA)
Source
- Lewandowski C, Santhakumar S. Posterior Circulation Stroke. Foundation for Education and Research in Neurologic Emergencies (FERNE). Review Article.