What are the clinical manifestations of ischemia in the cerebellar vermis?

From the Guidelines

Ischemia in the cerebellar vermis primarily manifests as truncal ataxia, characterized by impaired balance and coordination of the trunk and proximal limbs, as well as symptoms such as dizziness, vertigo, and vomiting, which can be difficult to diagnose without careful attention to speech, gait, coordination, and eye movements 1. The clinical presentation of vermis ischemia can be subtle, with patients often presenting with non-specific symptoms such as dizziness, vertigo, and vomiting, making it a common pitfall to miss truncal ataxia during a bedside examination 1. Key features of vermis ischemia include:

• Truncal ataxia, characterized by a wide-based, unsteady gait, difficulty sitting upright without support, and truncal swaying or titubation
• Impaired balance and coordination of the trunk and proximal limbs
• Vertigo, nausea, vomiting, and dysarthria
• Potential for cerebellar edema, obstructive hydrocephalus, and brainstem compression in severe cases, particularly with extensive posterior inferior cerebellar artery (PICA) territory involvement 1. It is essential to carefully evaluate patients with suspected cerebellar infarction, as the initial CT can be normal in as many as 25% of patients, and peak swelling can occur several days after the onset of ischemia, leading to potentially life-threatening complications 1.

From the Research

Clinical Manifestation of Ischemia in the Vermis of Cerebellum

• The clinical manifestation of ischemia in the vermis of the cerebellum can include truncal and gait ataxia, as well as rotatory vertigo, particularly if the infarction involves the nodulus in the caudal vermis 2.
• The rostral vermis, which receives input from the dorsal spinocerebellar tract (DSCT), may exhibit truncal and gait ataxia without rotatory vertigo 2.
• Infarction of the vermis and tonsil can also cause lateropulsion, gaze-evoked nystagmus, and vestibular pathway dysfunction 2.
• Cerebellar ischemic stroke can present with vertigo, hearing loss, and other neurological symptoms, depending on the location and extent of the infarction 3.
• The clinical picture of cerebellar disease is often dominated by motor disturbances, but can also include cognitive dysfunction, dysarthria, and oculomotor dysfunction 4, 5.

Specific Symptoms and Signs

• Truncal and gait ataxia are common symptoms of vermis infarction 2.
• Rotatory vertigo is often present in infarction of the nodulus in the caudal vermis 2.
• Lateropulsion, gaze-evoked nystagmus, and vestibular pathway dysfunction can occur in infarction of the tonsil and nodulus 2.
• Cerebellar ischemic stroke can cause vertigo, hearing loss, and other neurological symptoms, depending on the location and extent of the infarction 3.

Diagnostic Assessment and Treatment

• A comprehensive examination of central ocular motor and vestibular function is key to diagnosing cerebellar dizziness and vertigo 6.
• Patients with cerebellar dizziness and vertigo may require multimodal treatment, including balance training, occupational therapy, and medication 6.