Cerebellar Stroke

A stroke involving the cerebellum is one of the least common types of stroke, accounting for only about 3% of all strokes. Symptoms of cerebellar strokes are easily confused with other illnesses, such as stomach flu. However, cerebellar strokes are particularly dangerous and prone to serious complications because of the unique location of the cerebellum. If you or a loved one has had a cerebellar stroke, you can find answers to your questions here.

What is the cerebellum?

The cerebellum is a part of the brain that controls balance and coordination of the body and coordination of eye movements. The cerebellum is at the lower back of the brain and it has a right and left side, which are identical in appearance, each side controlling the coordination of the body that is on the same side as the cerebellum.

What is a cerebellar stroke?

A cerebellar stroke occurs when a blood vessel leading to a portion of the cerebellum is blocked or bleeding, interrupting blood supply to a region of the cerebellum.

The cerebellum is small, but because there are several blood vessels that provide nutrient rich blood to the cerebellum, a cerebellar stroke typically involves only one section or one side of the cerebellum, producing symptoms that affect one side of the body.

The blood vessels that reach the cerebellum are called the superior cerebellar artery, the anterior inferior cerebellar artery, and the posterior inferior cerebellar artery.

Any blood clot or bleeding or trauma to these blood vessels causes a cerebellar stroke.

What are symptoms and effects of cerebellar stroke?

A cerebellar stroke most often causes dizziness, headaches, nausea and vomiting. Additionally, people with a cerebellar stroke may have difficulty walking, trouble with coordination, double vision, tremors and trouble speaking.

Nonspecific neurological symptoms such as dizziness and headaches are more common in people who experience a cerebellar stroke than obvious vision or coordination problems. Therefore, many people with cerebellar stroke initially ignore the symptoms and do not get medical attention until after the symptoms become severe or persistent. And, studies show that even when people with cerebellar strokes receive medical attention, they are often misdiagnosed with migraine headaches or stomach flu because the vomiting and headaches are so much more noticeable than the neurological problems.

There are some trademark stroke signs that may be present when someone has a cerebellar stroke, and this can help identify a stroke. These include jerking of the arms or legs, subtle shaking of the body, and a jerking appearance of the eyes when they move from left to right. However, not everyone with cerebellar stroke has these signs- it depends on how large the stroke is.

A standard brain CT scan typically does not reveal a cerebellar stroke due where the cerebellum is, which is low in the brain and protected by bone, making it difficult to visualize on a standard brain CT.

A brain MRI can better visualize the cerebellum, but because MRI requires a longer time to complete, it is not typically considered safe to have an emergency brain MRI if you are neurologically unstable. These factors all contribute to the frequent misdiagnosis of cerebellar stroke.

What are the complications of cerebellar stroke?

A cerebellar stroke causes coordination problems of the body, typically on one side. One-sided coordination problems can cause significant impairment of walking. Double vision and speech problems, tremors and jerking movement may result from a cerebellar stroke. 

Serious short-term complications include swelling of the brain, which leads to compression of the brain within the skull, potentially causing further damage to the cerebellum or the brainstem or other regions of the brain. In the long-term, swelling or excessive bleeding can interfere with the normal flow of cerebrospinal fluid around the brain and spine, causing a buildup of fluid, a condition called hydrocephalus. This condition often requires long-term intervention.

What are the risk factors for cerebellar stroke?

A blood clot, bleeding or trauma can cause a cerebellar stroke. The risk factors for a blood clot causing a cerebellar stroke are the same as the risk factors for any ischemic stroke in any part of the brain. These include smoking, hypertension, elevated fat and cholesterol levels, heart disease and diabetes. The risk factors for a cerebellar hemorrhagic stroke include extreme hypertension or a ruptured brain aneurysm. And neck trauma to the back of the neck may injure the blood vessels that supply the cerebellum, leading to an ischemic or a hemorrhagic stroke.

What to expect from a cerebellar stroke?

Generally, a cerebellar stroke requires a careful evaluation to determine whether there is a brain aneurysm or any unusual blood vessel that could lead to another stroke. Careful management of bleeding and swelling is necessary to prevent hydrocephalus. You should expect close medical monitoring after a cerebellar stroke, even if your symptoms do not seem too severe.

Physical therapy is a cornerstone of recovery, particularly when it comes to regaining balance and learning how to walk safely. Over time, tremors and jerking movements may improve. Double vision is a danger in driving and may cause headaches, but it may improve slowly over time.

Sources:

Acute stroke chameleons in a university hospital: Risk factors, circumstances, and outcomes, Richoz B, Hugli O, Dami F, Carron PN, Faouzi M, Michel P, Neurology, August 2015

Cerebellar infarction, Datar S, Rabinstein AA, Neurologic Clinics, November 2014

Misdiagnosis of cerebellar infarctions, Sangha N, Albright KC, Peng H, Vahidy F, Boehme A, Chen Z, Savitz SI, The Canadian Journal of Neurological Sciences, September 2014

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