From the Guidelines
Treatment of dizziness related to cerebellar stroke should prioritize addressing the underlying stroke while managing symptoms, with a focus on hospital admission for close neurological monitoring and supportive care to prevent deterioration due to edema and brainstem compression, as recommended by the 2018 guidelines for the early management of patients with acute ischemic stroke 1. The initial management of cerebellar stroke-induced dizziness includes hospital admission for close monitoring, as these strokes can rapidly deteriorate due to edema and brainstem compression, highlighting the importance of early detection and intervention, as noted in the 2014 recommendations for the management of cerebral and cerebellar infarction with swelling 1. Key aspects of treatment include:
- Supportive care with intravenous fluids to maintain cerebral perfusion
- Antiplatelet therapy, such as aspirin or clopidogrel, for secondary stroke prevention unless hemorrhagic stroke is present
- Neurosurgical intervention, like suboccipital decompressive craniectomy, for severe cases with significant edema causing brainstem compression, as supported by the 2018 guidelines 1
- Symptomatic management of dizziness with vestibular suppressants, but with caution to avoid delaying central compensation
- Vestibular rehabilitation therapy once medically stable to promote neuroplasticity and compensation for vestibular deficits
- Long-term management focusing on risk factor modification, including blood pressure control, diabetes management, smoking cessation, and cholesterol management, to reduce the risk of further strokes and improve overall outcomes, as emphasized in the guidelines 1. It is crucial to consider the individual patient's needs and preferences in the treatment plan, especially in cases where the outcome may be uncertain, and to involve patients and their caregivers in shared decision-making, as recommended in the 2018 guidelines 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. The treatment of dizziness related to cerebellar stroke may involve the use of medications such as meclizine to address vertigo associated with vestibular system diseases.
- The primary goal is to alleviate symptoms of vertigo and dizziness.
- Treatment should be individualized and based on the specific needs of the patient. 2
From the Research
Principles of Treatment for Dizziness Related to Cerebellar Stroke
The treatment for dizziness related to cerebellar stroke involves a multimodal approach, including:
- Balance training
- Occupational therapy
- Medication 3 Vestibular rehabilitation therapy (VRT) is also an effective treatment for dizziness, aiming to promote vestibular adaptation and substitution, enhance gaze stability, postural stability, and improve vertigo and activities of daily living 4.
Key Exercises for Vestibular Rehabilitation
The key exercises for VRT include:
- Head-eye movements with various body postures and activities
- Maintaining balance with a reduced support base with various orientations of the head and trunk
- Repeating movements that provoke vertigo
- Exposing patients to various sensory and motor environments 4
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of cerebellar infarction are crucial to prevent complications such as brainstem compression and obstructive hydrocephalus 5. Identification and treatment of underlying vascular lesions can also prevent subsequent occurrences of stroke and improve patient outcomes.
Treatment Outcomes
Studies have shown that patients with cerebellar dizziness and vertigo can improve with treatment, including vestibular rehabilitation and multimodal therapy 6, 3. Audiovestibular loss from cerebellar infarction has a relatively good long-term outcome, with approximately half of patients experiencing true vertigo 7.