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83: CEREBELLAR STROKE

Mollie Venglar, DSc, MSPT, NCS

CONDITION/DISORDER SYNONYM

  • Cerebellar hemorrhage

ICD-9-CM CODE

  • 431 Intracerebral hemorrhage

ICD-10-CM CODE

  • I61.4 Nontraumatic intracerebral hemorrhage in cerebellum

PREFERRED PRACTICE PATTERN

  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—acquired in adolescence or adulthood1

PATIENT PRESENTATION

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.

KEY FEATURES

Description

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

Essentials of Diagnosis

  • 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.

General Considerations

  • Can be life threatening depending on the size of hematoma

  • Generally hematoma causes pressure in area of the fourth ventricle

    • Blocking fourth ventricle leads to hydrocephalus

    • Increased pressure in area of the fourth ventricle causes damage to the brain stem

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

    • Cerebellar stroke due to hemorrhage considered medical emergency

FIGURE 83-1

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.)

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FIGURE 83-2

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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