From the Guidelines
A small lesion in the inferior left cerebellar hemisphere would likely cause ipsilateral cerebellar symptoms including limb ataxia on the left side, difficulty with fine motor coordination in the left arm and leg, intention tremor, dysmetria, and dysdiadochokinesia. The patient may also experience gait ataxia with a tendency to veer or fall toward the left side. Nystagmus might be present, and some patients may report vertigo, nausea, or vomiting, as cerebellar infarction can be difficult to diagnose, especially when the chief complaints are dizziness, vertigo, and vomiting 1. Speech could be affected with mild dysarthria. Since the lesion is small, symptoms may be subtle and limited to the left side of the body. These manifestations occur because the cerebellum controls coordination, precision, and timing of movements, with each hemisphere primarily influencing the ipsilateral side of the body. The inferior cerebellar region specifically relates to coordination of the limbs and trunk. Some key symptoms to look out for include:
- Limb ataxia on the left side
- Difficulty with fine motor coordination in the left arm and leg
- Intention tremor
- Dysmetria (overshooting targets)
- Dysdiadochokinesia (impaired rapid alternating movements)
- Gait ataxia with a tendency to veer or fall toward the left side
- Nystagmus
- Vertigo, nausea, or vomiting
- Mild dysarthria It is essential to carefully attend to speech, gait, coordination, and eye movements to make the diagnosis, as few reliable clinical signs and symptoms can serve to stratify cerebellar stroke patients across a continuum of clinical severity 1. Ischemic lesions result from inadequate blood supply, commonly from vertebral or posterior inferior cerebellar artery (PICA) occlusion. Symptoms typically develop suddenly and may improve over time as brain plasticity allows for compensation.
From the Research
Expected Symptoms
The expected symptoms from a small lesion, possibly ischemic, at the inferior left cerebellar hemisphere can include:
- Ataxia and tremor, as well as nystagmus, dysarthria, and cognitive dysfunction 2
- Vertigo without other localizing symptoms, as a small infarct in the cerebellum can present with vertigo without other neurological symptoms or signs 3
- Dysarthria, which is a frequent symptom in cerebral ischemia, and can be associated with a classic lacunar stroke syndrome 4
- Balance and walking deficits, reflecting the cerebellum's role in coordination, sensory integration, and motor learning 5
- Cerebellar ataxia, which can be associated with ataxia, dysarthria, dysmetria, nystagmus, and cognitive deficits 6
Lesion Location and Symptoms
The location of the lesion in the inferior left cerebellar hemisphere can affect the symptoms presented. For example:
- Infarctions in the territory of the medial branch of the posterior inferior cerebellar artery (PICA) can present with vertigo without other localizing symptoms 3
- Infarctions in the territory of the anterior inferior cerebellar artery (AICA) can cause audiovestibular dysfunction, including hearing loss and vertigo 3
- Lesions in the cerebellum can also cause dysarthria, which can be associated with a classic lacunar stroke syndrome or with isolated cerebellar infarctions 4
Clinical Presentation
The clinical presentation of a small lesion, possibly ischemic, at the inferior left cerebellar hemisphere can vary depending on the extent and site of cerebellar damage and extracerebellar signs. The symptoms can include a combination of: