Symptoms of Cerebellar Stroke
Cerebellar infarction often presents with dizziness, vertigo, and vomiting, making it difficult to diagnose as these symptoms can mimic benign conditions such as viral gastroenteritis or labyrinthitis. 1, 2
Common Presenting Symptoms
- Dizziness, vertigo, and vomiting are the most common initial complaints 2, 3
- Unsteady gait and difficulty with coordination 1, 3
- Headache 3
- Nausea 1
- Truncal ataxia, which is commonly missed during bedside examination 1
- Speech disturbances 1
Specific Neurological Findings
- Impaired coordination and gait abnormalities requiring careful assessment 1
- Abnormal eye movements that need detailed examination 1, 4
- Hearing loss, particularly common with anterior inferior cerebellar artery infarction 1, 4
- Intractable hiccups may be seen in posterior inferior cerebellar artery infarction 1
Signs of Deterioration
- Decreased level of consciousness - the most reliable clinical symptom of tissue swelling 1
- Pontine compression leading to ophthalmoparesis (abnormal eye movements) 1
- Breathing irregularities and cardiac dysrhythmias 1
- Pupillary anisocoria (unequal pupils) or pinpoint pupils 1, 5
- Loss of oculocephalic responses 1, 5
- Bradycardia and irregular breathing patterns 1, 5
- Sudden apnea in severe cases 1, 5
Diagnostic Challenges
- Initial CT can be normal in as many as 25% of patients 1
- Symptoms may be mistaken for benign peripheral vestibular disorders 3, 6
- Truncal ataxia is frequently missed during bedside examination 1
- Normal head impulse test results can help differentiate cerebellar infarction from acute peripheral vestibulopathy 4
Territory-Specific Symptoms
- Posterior inferior cerebellar artery (PICA) territory: vertigo, nausea, vomiting, and intractable hiccups 1, 4
- Anterior inferior cerebellar artery (AICA) territory: vertigo with unilateral hearing loss, which patients might not notice 4
- Superior cerebellar artery territory: less commonly associated with vertigo but more with limb ataxia 4
Complications
- Swelling after cerebellar infarction may result in pontine compression 1, 5
- Acute hydrocephalus secondary to obstruction of the fourth ventricle 1, 5
- Peak swelling typically occurs several days after the onset of ischemia 1
- Deterioration depends more on initial infarct volume rather than specific vascular territory 1
Clinical Monitoring
- Patients with cerebellar stroke should be closely monitored for level of arousal or new brainstem signs 5
- Clinical deterioration typically manifests as brainstem compression, depression in consciousness level, Glasgow Coma Scale score <12 on admission, or a decline of ≥2 points 5
- Radiographic deterioration appears as fourth ventricular compression and evidence of hydrocephalus 5
- Patients with territorial cerebellar infarctions require monitoring for up to 5 days, even if initially stable 5
Recognizing these symptoms promptly is crucial as cerebellar stroke can rapidly deteriorate into a life-threatening condition requiring urgent intervention 7, 3.