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  • Cerebellar hemorrhage

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  • 431 Intracerebral hemorrhage

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  • I61.4 Nontraumatic intracerebral hemorrhage in cerebellum

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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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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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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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Medications

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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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  • Arousal
  • Cranial nerve integrity
  • Peripheral nerve integrity
  • Gait
  • Wheelchair mobility
  • Balance
    • Static sit
    • Dynamic sit
    • Static stand
    • Dynamic stand
    • Moving base of support
  • Muscle strength (appearance of weakness may be an issue of low tone)
  • Muscle recruitment
  • Coordination
  • Postural control
  • Posture
  • Reflexes
    • Deep tendon
    • Babinski
    • Clonus
  • Muscle tone
  • Motor planning
  • Bed mobility
  • Transfers
  • ...

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