From the Guidelines
Symptoms of a cerebellar stroke include dizziness, vertigo, vomiting, and difficulties with speech, gait, coordination, and eye movements, which can be subtle and easily missed, especially truncal ataxia, and may progress to more severe symptoms such as decreased level of consciousness, ophthalmoparesis, breathing irregularities, and cardiac dysrhythmias if swelling occurs 1. The diagnosis of cerebellar infarction can be challenging due to its non-specific symptoms, and careful attention to the patient's clinical presentation is required. Some patients may experience hearing loss, intractable hiccups, or visual disturbances, depending on the specific area of the cerebellum affected. It is essential to note that the initial CT scan can be normal in up to 25% of patients, making clinical evaluation crucial for diagnosis 1. Key symptoms to look out for include:
- Sudden onset of dizziness or vertigo
- Loss of balance or coordination
- Difficulty walking or standing
- Nausea and vomiting
- Slurred speech or difficulty with speech
- Visual disturbances
- Weakness on one side of the body
- Difficulty with fine motor movements
- Decreased level of consciousness
- Ophthalmoparesis
- Breathing irregularities
- Cardiac dysrhythmias If these symptoms occur, especially severe dizziness with inability to walk, it is critical to seek emergency medical attention immediately, as prompt treatment can minimize brain damage and improve outcomes 1.
From the Research
Symptoms of Cerebellar Stroke
The symptoms of cerebellar stroke (cerebellum infarction) include:
- Nausea and vomiting 2, 3
- Dizziness 2, 3
- Unsteady gait 3
- Headache 3
- Decreased proximal strength 4
- Whole body ataxia 4
- Vertical diplopia 4
- Dysphagia 4
- Difficulty communicating 4
- Emotional lability 4
Diagnosis and Misdiagnosis
Cerebellar infarction is often misdiagnosed due to its non-specific symptoms, which can mimic benign conditions such as viral gastroenteritis or labyrinthitis 2, 3. Accurate diagnosis relies on careful attention to patients' coordination, gait, and eye movements, as well as imaging tests such as MRI 3, 5. Misdiagnosis is more frequent in patients below 60 years of age, those with vertebral artery dissection, and those screened only by brain CT 6.
Complications
Large infarctions or those with hemorrhagic conversion can lead to tissue swelling and complications such as obstructive hydrocephalus and brainstem compression 2, 3. Early correct diagnosis is crucial to prevent these complications and improve patient outcomes 3.