From the Guidelines
Cerebellar strokes are primarily caused by either ischemia or hemorrhage, with the most common etiologies being atherosclerosis of the vertebrobasilar arterial system, cardioembolism, small vessel disease, and hypertension. The vertebrobasilar arterial system, which includes the posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), and superior cerebellar artery (SCA), is often affected by atherosclerosis, leading to ischemic cerebellar strokes 1. Cardioembolism, where blood clots form in the heart and travel to the cerebellar arteries, is another significant cause, often due to atrial fibrillation, valvular heart disease, or recent myocardial infarction. Small vessel disease related to chronic hypertension and diabetes can lead to lacunar infarcts in the cerebellum. Hemorrhagic cerebellar strokes commonly result from hypertension causing rupture of small vessels, arteriovenous malformations, or cerebral amyloid angiopathy in older patients.
Some key points to consider in the etiology of cerebellar strokes include:
- Atherosclerosis of the vertebrobasilar arterial system is a common cause of ischemic cerebellar strokes 1
- Cardioembolism is a significant cause of ischemic cerebellar strokes, often due to atrial fibrillation, valvular heart disease, or recent myocardial infarction 1
- Small vessel disease related to chronic hypertension and diabetes can lead to lacunar infarcts in the cerebellum 2
- Hemorrhagic cerebellar strokes commonly result from hypertension causing rupture of small vessels, arteriovenous malformations, or cerebral amyloid angiopathy in older patients 3
- Less common causes include vertebral artery dissection, vasculitis affecting cerebral blood vessels, and coagulopathies that increase bleeding risk 1
Understanding these etiologies is crucial for appropriate management and prevention strategies, as highlighted in the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack 1. This guideline recommends diagnostic evaluations, including ECG, noninvasive cervical carotid imaging, CT or MRI of the brain, and blood tests, to gain insights into the etiology of and plan optimal strategies for preventing recurrent stroke.
From the Research
Etiology of Cerebellar Stroke
The etiology of cerebellar stroke is complex and multifactorial. Several studies have investigated the causes and risk factors associated with cerebellar stroke.
- Cerebellar stroke can result from various mechanisms, including ischemia and hemorrhage 4.
- Ischemic strokes in the cerebellum can be caused by small vessel arteriolosclerosis, cardioembolism, and large artery athero-thromboembolism 4.
- Intracerebral hemorrhage, which can occur in the cerebellum, is often caused by deep perforator (hypertensive) arteriopathy or cerebral amyloid angiopathy 4.
- Cerebellar stroke can also be caused by other factors, such as vascular malformations, aneurysms, and venous sinus thrombosis, particularly in young patients 4, 5.
Risk Factors for Cerebellar Stroke
Several risk factors have been identified as contributing to the development of cerebellar stroke.
- Hypertension is a major modifiable risk factor for stroke, including cerebellar stroke 4, 6.
- Diabetes mellitus, high low-density lipoprotein, hypertriglyceridemia, and smoking are also independent risk factors for cerebral small vessel disease, which can lead to cerebellar stroke 6.
- The presence of small vessel disease, as indicated by cerebral microbleeds and white matter hyperintensities, is associated with an unfavorable outcome in stroke patients on oral anticoagulation 7, 8.
Clinical Presentation and Outcome
Cerebellar stroke can present with a range of symptoms, including ataxia, dysarthria, and vertigo.
- The clinical presentation of cerebellar stroke can be similar in children and adults, but the symptoms may be overlooked in young patients 5.
- The outcome of cerebellar stroke can be severe, with a high risk of recurrent ischemic stroke and intracranial hemorrhage, particularly in patients with small vessel disease 7, 8.