PREFERRED PRACTICE PATTERN
A 42-year-old woman experiences surgical evacuation of a hemorrhage in the midline of her cerebellum. Intracranial pressures appear to be controlled and she is now allowed to participate in therapies. She reports nausea with most upright, unsupported activities. She struggles to maintain proper trunk alignment and control during static sitting at the side of the hospital bed and relies on her upper extremities to help her stay upright. She has no difficulty with cognitive tests but is easily distracted by the sensations of vertigo and nausea. On attempts to ambulate, she lists to the left and requires maximum assistance to keep her trunk in midline. She does not demonstrate any visual field cuts. She does not tolerate testing for dynamic visual acuity, vestibulo-ocular reflex (VOR), or head thrust due to nausea.
Stroke, usually due to hemorrhage, affecting the hemispheres, vermis, or flocculonodular lobe of the cerebellum
Most prominent feature of acute cerebellar stroke is repeated vomiting.
Patient will experience occipital headache, vertigo, difficulty remaining upright, walking.
Most cases show mild unilateral facial weakness and decreased corneal reflex.
May exhibit dysarthria or dysphagia.
Anatomic relationships in deep cerebral hemorrhage. Top: Plane of section. Bottom: Putaminal (1) and thalamic (2) hemorrhages can compress or transect the adjacent posterior limb of the internal capsule. Thalamic hemorrhages can also extend into the ventricles or compress the hypothalamus or midbrain upgaze center (3). (From Greenberg DA, Aminoff MJ, Simon RP. Clinical Neurology. 8th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Large intracerebral hemorrhage caused by hypertensive stroke in a nulliparous woman whose blood pressure was recorded at 270/140 mm Hg. (From Cunningham FG, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics. 23rd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
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