Related Subjects:
|Acute Stroke Assessment (ROSIER&NIHSS)
|Causes of Stroke
Cerebellar ischaemic stroke occurs when blood flow to the cerebellum is interrupted, causing infarction.
Although <5% of all strokes, they can be life-threatening due to posterior fossa crowding → brainstem compression & obstructive hydrocephalus.
🚨 Early recognition + treatment are vital.
📌 About
- ⏳ <5% of strokes, but risk of rapid deterioration.
- 🔬 MRI detects small (<2 cm) cerebellar infarcts often with benign prognosis.
- 💥 Even small oedema can dangerously ↑ ICP or compress the brainstem.
- 🧪 Swelling = cytotoxic + vasogenic oedema.
🩸 Blood Supply
- SCA (Superior Cerebellar Artery): superior cerebellum, midbrain, pons.
- AICA (Anterior Inferior Cerebellar Artery): anterior–inferior cerebellum + lateral pons; labyrinthine branch → inner ear.
- PICA (Posterior Inferior Cerebellar Artery): posterior–inferior cerebellum + lateral medulla.
🩻 Venous drainage → superior & inferior cerebellar veins → petrosal, transverse & straight sinuses.
⚠️ Aetiology
- 🫀 Large artery atherosclerosis (vertebrobasilar, artery-to-artery embolism).
- ❤️ Cardioembolism: AF, LV aneurysm, IE, post-MI.
- 🪢 Vertebral artery dissection (trauma, manipulation).
- 🩺 Procedural: e.g. post-cardiac catheterisation.
- 🧬 Others: PFO paradoxical embolus, thrombophilia, vasculitis.
🩺 Clinical Features
- 🎢 Vertigo/dizziness ± vomiting (sudden severe).
- 🤕 Occipital headache.
- 🚶 Ataxia: ipsilateral limb/gait ataxia.
- 👀 Nystagmus: horizontal or vertical.
- 🗣 Dysarthria/dysphagia: CN nuclei involvement.
- 👁 Diplopia.
- 😴 ↓ Consciousness → brainstem compression.
- 🔥 Horner’s syndrome: ptosis + miosis + anhidrosis.
- 🦶 Positive Babinski: CST involvement.
- 💔 Cardiac findings: AF, post-MI clues to embolic source.
🔑 Exam pearl: Vertigo + ataxia + dysarthria + nystagmus = think cerebellar stroke, not just vestibular disease.
🆚 Differentials
- 🦻 Labyrinthitis / Vestibular neuritis (peripheral vertigo).
- 🍺 Alcohol intoxication.
- 💊 Phenytoin / anticonvulsant toxicity.
- 🧬 Multiple sclerosis.
- 🎗 Posterior fossa tumour.
⚠️ Complications
- 💧 Hydrocephalus: 4th ventricle obstruction.
- 🧩 Brainstem compression: oedema + herniation risk.
- 😴 Coma/resp arrest: brainstem failure.
- 🫁 Aspiration pneumonia (swallowing dysfunction).
- 🦵 DVT/PE: immobility complications.
🔍 Investigations
- 🩸 Bloods: FBC, U&E, glucose, lipids, coagulation.
- 📉 ECG: AF, arrhythmias.
- 🫁 CXR: cardiac size, infection.
- 🖼 CT: excludes bleed; may show infarct late.
- 🧲 MRI DWI: sensitive for acute infarct.
- 🖼 CTA/MRA: vertebrobasilar occlusion, dissection.
- 🫀 Echo: embolic source.
⚕️ Management
- 🛌 Stabilisation: ABCs, ICU/HDU, close neuro obs.
- 💉 IV thrombolysis: if <4.5h, no contraindications.
- 🧑⚕️ Thrombectomy: selected posterior circulation occlusions.
- 💊 Antiplatelet: aspirin 300mg if not thrombolysed, after bleed excluded.
- 🧠 ICP management: head elevation, mannitol/hypertonic saline, neuro referral.
- 🔪 Neurosurgery: decompressive suboccipital craniectomy, EVD if hydrocephalus.
- 🤝 Supportive: DVT prophylaxis, swallow safety, physio/OT/speech rehab.
- 🛡 Secondary prevention: anticoagulate AF, statins, control BP, stop smoking.
📈 Prognosis
- 🌱 Small infarcts: often good recovery.
- ⚡ Large strokes: high mortality due to mass effect.
- 🔪 Early decompression: can save lives and improve outcomes.
📚 References
- Adams & Victor’s Principles of Neurology – Cerebellar Stroke.
- AHA/ASA Guidelines for Acute Ischaemic Stroke.
- Edlow JA, Newman-Toker DE. Acute dizziness diagnostic approach. J Emerg Med. 2008.
- Voetsch B et al. Basilar artery occlusive disease. Arch Neurol. 2004.
