Differential Diagnosis for Cryptogenic Cerebellar Stroke
Single Most Likely Diagnosis
- Cardioembolic stroke due to atrial fibrillation: This is often a common cause of cryptogenic stroke, as the arrhythmia may be paroxysmal and thus not detected during routine monitoring. The cerebellum's vascular supply, primarily from the posterior circulation, makes it susceptible to embolic events.
Other Likely Diagnoses
- Small vessel disease: Although more commonly associated with lacunar infarcts in the basal ganglia, thalamus, or pons, small vessel disease can also affect the cerebellum, leading to stroke.
- Patent foramen ovale (PFO): A PFO can be a source of paradoxical embolism, potentially leading to a cryptogenic stroke, including in the cerebellum.
- Coagulopathy or hypercoagulable state: Conditions such as factor V Leiden mutation, antiphospholipid syndrome, or protein C/S deficiency can increase the risk of stroke, including cryptogenic cerebellar stroke.
Do Not Miss Diagnoses
- Dissection of the vertebral or basilar artery: Although less common, dissections in these arteries can lead to cerebellar stroke and are critical to identify due to their potential for significant morbidity and mortality if not promptly treated.
- Vasculitis (e.g., giant cell arteritis, primary central nervous system vasculitis): These conditions can cause stroke and are important to diagnose due to their need for specific treatment to prevent further vascular events.
- Moyamoya disease: A rare condition characterized by progressive stenosis of the internal carotid arteries and their branches, which can lead to stroke, including in the cerebellum if the posterior circulation is involved.
Rare Diagnoses
- Cerebral amyloid angiopathy: More commonly associated with lobar hemorrhages, in rare cases, it can cause ischemic strokes, including in the cerebellum.
- Fabry disease: A genetic disorder that can lead to vascular dysfunction and stroke, including cryptogenic cerebellar stroke, due to the accumulation of globotriaosylceramide in vascular endothelial cells.
- Susac syndrome: A rare condition characterized by microangiopathic changes in the brain, retina, and cochlea, which can lead to stroke, including in the cerebellum.