From the Guidelines
Symptoms of a cerebellar stroke include dizziness, vertigo, vomiting, and difficulties with speech, gait, coordination, and eye movements, as highlighted in the 2014 American Heart Association/American Stroke Association statement 1. These symptoms can be subtle and easily missed, especially if the patient presents with non-specific complaints such as dizziness or vertigo. It is essential to carefully assess the patient's speech, gait, coordination, and eye movements to make an accurate diagnosis. Some patients may also experience truncal ataxia, which can be overlooked during a bedside examination.
Key symptoms to look out for include:
- Sudden onset of dizziness or vertigo
- Vomiting
- Difficulty with speech, gait, and coordination
- Eye movement abnormalities
- Decreased level of consciousness or arousal
- Ophthalmoparesis (weakness or paralysis of the eye muscles)
- Breathing irregularities
- Cardiac dysrhythmias
- Hearing loss (particularly with anterior inferior cerebellar infarction)
- Intractable hiccups (with posterior inferior cerebellar infarction)
It is crucial to recognize that the initial CT scan can be normal in up to 25% of patients with cerebellar stroke, and peak swelling may occur several days after the onset of ischemia 1. Therefore, a high index of suspicion and close monitoring are essential to ensure prompt diagnosis and treatment. Prompt medical attention is critical, as timely intervention can significantly improve outcomes in patients with cerebellar stroke.
From the Research
Symptoms of Cerebellar Stroke
The symptoms of cerebellar stroke can be non-specific and may mimic benign conditions, making diagnosis challenging. Some common symptoms include:
- Nausea and vomiting 2, 3, 4
- Dizziness or vertigo 2, 3, 4
- Unsteady gait or ataxia 3, 4
- Headache 3, 4
- Coma or altered mental status in severe cases 5
Clinical Presentation
The clinical presentation of cerebellar stroke can vary depending on the location and severity of the stroke. Some patients may present with mild symptoms, while others may deteriorate rapidly into a life-threatening condition 5. The diagnosis of cerebellar stroke often relies on careful attention to patients' coordination, gait, and eye movements, as well as imaging studies such as CT or MRI 3.
Diagnostic Challenges
The diagnosis of cerebellar stroke can be challenging due to the non-specific nature of the symptoms and the limited sensitivity of commonly used imaging tests such as CT scans 2, 6. A high index of suspicion and careful evaluation of the patient's history and physical examination are essential for making an accurate diagnosis 4.
Importance of Early Diagnosis
Early and correct diagnosis of cerebellar stroke is crucial to reduce morbidity and mortality 3, 4. Delayed diagnosis can lead to poor outcomes, including increased risk of complications such as brainstem compression and obstructive hydrocephalus 5, 3.