Cerebellar stroke
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
- Vestibular/otologic
- Benign paroxysmal positional vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Ménière's disease
- Ear foreign body
- Otic barotrauma
- Otosclerosis
- Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Dissection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
- Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
- Chronic renal failure
- Metabolic
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
- Early neurosurgical consultation is needed (herniation may lead to rapid deterioration)
- See Stroke (Main)
- See Thrombolysis in Acute Ischemic Stroke (tPA)