Welcome to Stroke Education.CO.UK

Learning objectives

  • Causes of Cerebellar Infarcts
  • Clinical presentation
  • Diagnosis and management
  • Role of surgical intervention

    About

  • Cerebellar signs may not just be due to cerebellar disease but also its connections to the brainstem
  • Less than 5 % of all strokes. Prognosis more benign than initially seen as smaller infarcts now diagnosed more.
  • Even small amounts of cerebellar oedema can acutely increase intracranial pressure (ICP) or directly compress the brainstem.
  • Localised swelling results from both cytotoxic and vasogenic edema
  • Very small cerebellar infarcts (diameter <2 cm) are a frequent finding on MRI. With an increasing scientific interest in cerebral microinfarcts, very small infarcts in the cerebellum have been referred to as lacunar infarcts, as junctional, border zone or watershed infarcts, as nonterritorial infarcts, as very small territorial or end zone infarcts, or simply as (very) small cerebellar infarcts

    Aetiology

  • Vertebrobasilar atherosclerosis with artery to artery embolism
  • Cardioembolism - AV, LV aneurysm, Endocarditis, STEMI
  • Aorta/Subclavian atherosclerosis with artery to artery embolism
  • Post Cardiac catheterisation

    Clinical

  • Vomiting, headache, Horner's syndrome
  • Ipsilateral limb ataxia, vertigo, nystagmus, past pointing,
  • Local oedema with coma and upgoing plantars
  • Head or neck pain consider vertebral artery dissection.
  • Look for AF and MI and other embolic causes

    Differentials

  • Labyrinthitis
  • Alcohol - its not unique for a person with a cerebellar stroke to spend a night in the drunk tank or the drunk person to be admitted as stroke
  • Drug toxicity - anticonvulsants

    Complications

  • Coma with Brainstem (pontine) compression and acute hydrocephalus due to obstruction of the IVth ventricle. Coma is most reliable clinical sign.
  • Aspiration, DVT/PE, Respiratory arrest

    Investigations

  • FBC, U&E, LFTs, Glucose, Lipids, ECG, CXR
  • CT may show evolved large infarct and hydrocephalus but normal early on
  • MRI: Positive DWI and increased signal on T2-weighted axial and coronal sections
  • MRA/CTA may show vertebrobasilar disease

    Management

  • Admit to HASU or ITU as needed. ABC. Comatose may need airway protection and intubated and ventilated. Coma usually develops post admission depending on onset time.
  • Alteplase may be considered if NIHSS > 3 / disabling stroke suspected
  • Aspirin 300 mg given if not thrombolysed or post lysis if CT no blood
  • Prophylactic suboccipital decompression of large cerebellar infarcts before brainstem compression, although not tested rigorously in a clinical trial, is practiced at most stroke centers.
  • External ventricular drainage may be considered


  • Top of Page