What are the symptoms of a right cerebellum infarct?

Symptoms of Right Cerebellar Infarction

The primary symptoms of right cerebellar infarction include ipsilateral limb ataxia, truncal ataxia, dysarthria, vertigo, nausea, vomiting, headache, and gait instability. 1, 2

Cardinal Clinical Features

Cerebellar Symptoms

• Ipsilateral limb dysmetria/ataxia: Affects the right side (same side as the infarct)
• Truncal ataxia: Difficulty maintaining posture while sitting or standing
• Dysarthria: Slurred speech
• Ipsilateral axial lateropulsion: Tendency to fall toward the right side
• Gait instability/unsteadiness: Often severe enough to prevent walking

Associated Symptoms

• Vertigo: Often severe and rotatory, especially with posterior inferior cerebellar artery involvement
• Nausea and vomiting: Present in many patients
• Headache: Common, particularly in the occipital region
• Dizziness: Frequently reported and may mimic peripheral vestibular disorders

Warning Signs of Deterioration

Cerebellar infarcts can initially present with mild symptoms but may deteriorate rapidly due to swelling, which can lead to:

• Decreased level of consciousness: The most reliable sign of tissue swelling 1
• Brainstem compression signs:
  • Ophthalmoparesis (eye movement abnormalities)
  • Breathing irregularities
  • Cardiac dysrhythmias
• Obstructive hydrocephalus: Due to fourth ventricle compression

Diagnostic Challenges

Right cerebellar infarction is frequently misdiagnosed due to:

1. Non-specific initial symptoms: Often mistaken for benign conditions like viral gastroenteritis or labyrinthitis 3
2. Limited neurological examination: Coordination, gait, and eye movement examinations are sometimes abbreviated 4
3. Imaging limitations: Early cerebellar infarction may not be visible on initial CT scans in up to 25% of cases 1

Vascular Territory Variations

Symptoms may vary depending on which cerebellar artery territory is affected:

• Posterior Inferior Cerebellar Artery (PICA): More severe vertigo and rotatory sensations 5
• Superior Cerebellar Artery (SCA): More prominent dysarthria and ataxia 5
• Anterior Inferior Cerebellar Artery (AICA): May include hearing loss and intractable hiccups 1

Clinical Examination Focus

When evaluating for possible cerebellar infarction, pay particular attention to:

• Eye movements: Nystagmus, ophthalmoparesis
• Coordination testing: Finger-to-nose, heel-to-shin tests (ipsilateral side)
• Gait assessment: Critical for diagnosis but often omitted in dizzy patients
• Truncal stability: Have patient sit on the edge of the bed without support

Pitfalls to Avoid

1. Missing truncal ataxia: A common error is failing to assess the patient's ability to sit unsupported 1
2. Relying solely on CT imaging: MRI is much more sensitive for early detection of cerebellar infarction
3. Attributing symptoms to peripheral causes: Always consider cerebellar stroke in patients with acute vertigo, especially with vascular risk factors
4. Delayed recognition of deterioration: Frequent neurological assessments are essential as deterioration typically occurs within 72-96 hours 1

Remember that cerebellar infarction can initially present with benign-appearing symptoms but may progress to life-threatening complications requiring urgent neurosurgical intervention. Early recognition and appropriate monitoring are essential for optimal outcomes.