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Condition/Disorder Synonyms

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  • Cerebellar hemorrhage

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ICD-9-CM Code

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  • 431 Intracerebral hemorrhage

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ICD-10-CM Code

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  • I61.4 Nontraumatic intracerebral hemorrhage in cerebellum

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Preferred Practice Pattern1

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Key Features

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Description

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  • Stroke, usually due to hemorrhage, affecting the hemispheres, vermis, or flocculonodular lobe of the cerebellum

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Essentials of Diagnosis

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  • 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

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General Considerations

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  • Can be life-threatening depending on size of hematoma

  • Generally hematoma causes pressure in area of the 4th ventricle

    • Blocking 4th ventricle leads to hydrocephalus

    • Increased pressure in area of the 4th ventricle causes damage to the brainstem

    • Patient's status can quickly deteriorate to coma as pressure builds

    • Cerebellar stroke due to hemorrhage considered medical emergency

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Demographics

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  • Can occur in any age group, either gender

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Clinical Findings

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Signs and Symptoms

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  • Occipital headache

  • Vertigo

  • Vomiting

  • Mild facial weakness

  • Dysphagia

  • Dysarthria

  • Gait ataxia

  • Asthenia

  • Limb ataxia

  • Asynergia

  • Dyssynergia

  • Dysmetria

  • Dysdiadochokinesia

  • Tremor

  • Postural instability

  • Hypotonia

  • Nystagmus

  • Titubation

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Functional Implications

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  • Loss of independence with all aspects of mobility, ADLs, self-care

  • Safety concerns for any activity requiring upright control

  • Impaired ability to interact effectively with immediate and community environments

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Possible Contributing Causes

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  • Hypertension (HTN)

  • Arteriovenous malformation (AVM)

  • Hyperlipidemia

  • Obesity

  • Smoking

  • Sedentary lifestyle

  • Peripheral vascular disease

  • Birth trauma

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Differential Diagnosis

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  • Transient ischemic attack (TIA)

  • Hydrocephalus

  • Cerebellar ataxia

  • Cerebellar degeneration

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Means of Confirmation or Diagnosis

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Imaging

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  • CT: accurate for cerebellar hemorrhage; to determine need for surgical evacuation

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Diagnostic Procedures

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  • Neurovascular tests

    • Neck flexion for meningeal irritation

    • Palpation of arteries

    • Auscultation of heart and blood vessels

    • Ophthalmic pressures

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Treatment

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Medications

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  • Mannitol at initial identification of hydrocephalus

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Referrals/Admittance

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  • To emergency room to assessment and management of medical emergency

  • To neurosurgeon for surgical evacuation of cerebellar hematoma

  • To physiatrist for specific rehabilitation; physiatrist will manage medications, symptoms, future needs if not managed by neurologist

  • To occupational therapist for ADL, fine-motor task retraining

  • To speech/language pathologist for speech and swallowing impairments

  • To support groups for patients and caregivers

  • To case management or social work for coordination of care

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