Cerebellar stroke

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Background

Clinical Features

  • Sudden inability to walk is common finding
  • May have additional signs of of Posterior Circulation Stroke- 5Ds: Dizziness (Vertigo), Dysarthria, Dystaxia, Diplopia, Dysphagia
  • Can be confused with acute vestibular syndrome (e.g. labyrinthitis)

Central vs. Peripheral Causes of Vertigo

Peripheral Central
Onset Sudden Sudden or slow
Severity Intense spinning Ill defined, less intense
Pattern Paroxysmal, intermittent Constant
Aggravated by position/movement Yes Variable
Nausea/diaphoresis Frequent Variable
Nystagmus Horizontal and unidirectional Vertical and/or multidirectional
Fatigue of symptoms/signs Yes No
Hearing loss/tinnitus May occur Does not occur
Abnormal tympanic membrane May occur Does not occur
CNS symptoms/signs Absent Usually present

Differential Diagnosis

Vertigo

Diagnosis

Exam

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

Management

Disposition

See Also

References