From the Guidelines

Anti-edema measures should be added in cerebellar infarction when there are signs of neurological worsening or increased intracranial pressure.

Patients with major infarctions are at high risk for complicating brain edema and increased intracranial pressure, and measures to lessen the risk of edema and close monitoring of the patient for signs of neurological worsening during the first days after stroke are recommended 1.
Decompressive surgical evacuation of a space-occupying cerebellar infarction is effective in preventing and treating herniation and brain stem compression 1.
Early transfer of patients at risk for malignant brain edema to an institution with neurosurgical expertise should be considered 1.

The American Heart Association/American Stroke Association guidelines recommend measures to lessen the risk of edema and close monitoring of the patient for signs of neurological worsening during the first days after stroke 1.
Decompressive suboccipital craniectomy with dural expansion should be performed in patients with cerebellar infarction causing neurological deterioration from brainstem compression despite maximal medical therapy 1.
The guidelines also recommend against the use of corticosteroids for treatment of cerebral edema and increased intracranial pressure complicating ischemic stroke 1.

From the Research

Anti-edema measures should be considered early in the treatment of cerebellar infarction, as up to 20% of patients may develop malignant edema and deteriorate clinically 2.
The rate of infarct-edema growth in the first 2 days after acute cerebellar stroke can be a predictor of the need for surgical intervention and poor neurological outcomes 2.
Early identification of patients at risk of developing malignant edema is crucial, and radiologic measures such as initial infarct size can aid in this identification 2.

Bilateral or multiple vascular territory involvement is more frequent in patients who require surgical intervention 2.
Infarct-edema growth rate over the first 2 days is an independent predictor of surgical intervention, with a greater growth rate indicating a higher likelihood of requiring surgery 2.
Early infarct-edema growth rate can also predict poor clinical outcome, independent of baseline infarct-edema volume, brainstem infarct, and NIHSS score 2.

Conventional anti-edema therapy may not be effective in all cases, and alternative treatments such as mixed vasopressin antagonism may be considered 3.
Maintaining normotension, normothermia, adequate ventilation, and oxygenation is crucial in the management of cerebral edema 4.
Various medical treatment strategies, including osmotherapeutics, hyperventilation, tromethamine, hypothermia, and barbiturate coma, have been proposed to control brain edema and reduce intracranial pressure, but their efficacy is not supported by level 1 evidence 5.
Surgical decompression, such as bilateral decompressive craniotomy, may be necessary in cases of extended cerebral edema 6.