From the Guidelines
A right cerebellar stroke typically presents with symptoms affecting the right side of the cerebellum, which controls coordination on the same side of the body, and immediate medical attention is crucial to prevent life-threatening complications such as brainstem compression. Common symptoms include ataxia (uncoordinated movements) on the right side, difficulty with balance and walking, a tendency to fall or veer toward the right side, and nystagmus (involuntary eye movements) 1. Patients may also experience dysmetria (overshooting targets) when reaching with the right arm, dysdiadochokinesia (inability to perform rapid alternating movements), and slurred speech (dysarthria). Nausea, vomiting, dizziness, and headache can occur due to increased intracranial pressure. Unlike strokes affecting the cerebral hemispheres, cerebellar strokes don't typically cause weakness or sensory loss, but rather coordination problems. The cerebellum's role in motor learning and coordination explains why these symptoms appear.
Key Considerations
- 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.
- Swelling after cerebellar infarction may result in pontine compression, acute hydrocephalus secondary to obstruction of the fourth ventricle, and often both 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.
- Treatment typically focuses on managing the stroke cause (anticoagulation for embolic strokes or blood pressure control for hemorrhagic strokes) and rehabilitation to improve coordination deficits.
Management
- Decompressive suboccipital craniectomy with dural expansion is a recommended treatment for patients with cerebellar infarction causing neurological deterioration from brainstem compression 1.
- Ventriculostomy to relieve obstructive hydrocephalus after a cerebellar infarct should be accompanied by decompressive suboccipital craniectomy to avoid deterioration from upward cerebellar displacement 1.
- Patients with cerebellar infarction should be admitted to intensive care or stroke units attended by skilled and experienced physicians such as neurointensivists or vascular neurologists 1.
From the Research
Right Cerebellar Stroke Symptoms
- The symptoms of right cerebellar stroke can include dizziness, nausea and vomiting, unsteady gait, and headache 2.
- Other symptoms may include vertigo, headache, vomiting, unsteadiness of gait, and dysarthria 3.
- Ataxia, characterized by gait and limb ataxia, dysarthria, and nystagmus, is also a common symptom of posterior circulation stroke, which can affect the right cerebellum 4.
- Clinical manifestations of cerebellar disease, including right cerebellar stroke, can also include tremor, nystagmus, dysarthria, and cognitive dysfunction 5.
Specific Symptoms
- Gait ataxia is almost always present in posterior circulation stroke, regardless of the lesion site, including right cerebellar stroke 4.
- Limb ataxia and dysarthria may be less frequent in right cerebellar stroke, particularly in posterior inferior cerebellar artery territory infarcts 3, 4.
- Nystagmus, when present, does not differ among different topographical patterns of posterior circulation stroke, including right cerebellar stroke 4.
Diagnosis and Treatment
- Accurate diagnosis of right cerebellar stroke frequently relies on careful attention to patients' coordination, gait, and eye movements, as well as imaging tests such as MRI or CT scans 2, 3.
- Treatment of right cerebellar stroke is mainly focused on preventing complications, such as brainstem compression and obstructive hydrocephalus, and improving patients' outcomes 2, 3.
- Rehabilitation and management of right cerebellar stroke may include motor rehabilitation, noninvasive cerebellar stimulation, and symptomatic treatment to prolong independence and maintain quality of life 6.