What are the effects of a cerebellar stroke (cerebral vascular accident)?

From the Guidelines

A cerebellar stroke is a life-threatening condition that requires immediate medical attention to prevent severe morbidity and mortality, and treatment should involve thrombolytic therapy, antiplatelet medications, and possibly surgical intervention with suboccipital decompression to alleviate brainstem compression 1. The effects of a cerebellar stroke can be devastating, with symptoms including sudden dizziness, vertigo, difficulty walking, slurred speech, nausea, vomiting, and coordination problems. According to the American Heart Association/American Stroke Association guidelines, cerebellar infarction can be difficult to diagnose, especially when the chief complaints are dizziness, vertigo, and vomiting, and careful attention to speech, gait, coordination, and eye movements is required to make the diagnosis 1.

Key Considerations

• Cerebellar stroke patients 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 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 outcome after cerebellar infarct can be good after sub-occipital craniectomy, and it may be reasonable to inform family members of this possibility 1.

Treatment and Prevention

• Treatment begins with immediate medical attention, typically involving thrombolytic therapy with intravenous tPA (tissue plasminogen activator) if within 4.5 hours of symptom onset.
• Antiplatelet medications like aspirin (325mg initially, then 81mg daily) or clopidogrel (75mg daily) are often prescribed.
• For hemorrhagic cerebellar strokes, blood pressure control and reversal of anticoagulation may be necessary.
• Recovery involves rehabilitation with physical, occupational, and speech therapy.
• Prevention strategies include blood pressure control (target <130/80 mmHg), antiplatelet therapy, statins for hyperlipidemia, diabetes management, smoking cessation, and lifestyle modifications.

From the Research

Effects of Cerebellar Stroke

• Cerebellar infarction can present with non-specific symptoms such as dizziness, nausea and vomiting, unsteady gait, and headache 2
• The differential diagnosis is broad and includes many common and benign causes, making accurate diagnosis crucial to prevent misdiagnosis and potentially fatal complications 2
• Early correct diagnosis is essential to help prevent treatable but potentially fatal complications, such as brainstem compression and obstructive hydrocephalus 2

Clinical Presentation

• Cerebellar stroke may present in a completely different way from common stroke syndromes in the anterior cerebral circulation 3
• It can initially mimic benign vestibular neuritis and may later deteriorate into a life-threatening neurologic state 3
• Posterior circulation stroke presents similarly in children and adults, but the possibly mild symptoms and signs at onset are frequently overlooked by parents and healthcare professionals 3

Treatment and Complications

• The identification and treatment of the underlying vascular lesions at an early stage can prevent subsequent occurrences of stroke and improve patients' outcomes 2
• Adding clopidogrel to aspirin may yield more beneficial outcomes than aspirin mono-therapy in reducing the risk of recurrent ischemic stroke, but increases the risk of bleeding 4, 5
• Dual-antiplatelet therapy with clopidogrel and aspirin is more effective than aspirin alone in reducing the risk for recurrent stroke, but increases major bleeding events 5