Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Cerebellar hemorrhage ++ 431 Intracerebral hemorrhage ++ I61.4 Nontraumatic intracerebral hemorrhage in cerebellum ++ 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System – acquired in adolescence or adulthood +++ 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 vomitingPatient will experience occipital headache, vertigo, difficulty remaining upright, walkingMost cases show mild unilateral facial weakness and decreased corneal reflexMay exhibit dysarthria or dysphagia +++ General Considerations ++ Can be life-threatening depending on size of hematoma Generally hematoma causes pressure in area of the 4th ventricleBlocking 4th ventricle leads to hydrocephalusIncreased pressure in area of the 4th ventricle causes damage to the brainstemPatient’s status can quickly deteriorate to coma as pressure buildsCerebellar stroke due to hemorrhage considered medical emergency +++ Demographics ++ Can occur in any age group, either gender +++ Signs and Symptoms ++ Occipital headacheVertigoVomitingMild facial weaknessDysphagiaDysarthriaGait ataxiaAstheniaLimb ataxiaAsynergiaDyssynergiaDysmetriaDysdiadochokinesiaTremorPostural instabilityHypotoniaNystagmusTitubation +++ Functional Implications ++ Loss of independence with all aspects of mobility, ADLs, self-careSafety concerns for any activity requiring upright controlImpaired ability to interact effectively with immediate and community environments +++ Possible Contributing Causes ++ Hypertension (HTN)Arteriovenous malformation (AVM)HyperlipidemiaObesitySmokingSedentary lifestylePeripheral vascular diseaseBirth trauma +++ Differential Diagnosis ++ Transient ischemic attack (TIA)HydrocephalusCerebellar ataxiaCerebellar degeneration +++ Imaging ++ CT: accurate for cerebellar hemorrhage; to determine need for surgical evacuation +++ Diagnostic Procedures ++ Neurovascular testsNeck flexion for meningeal irritationPalpation of arteriesAuscultation of heart and blood vesselsOphthalmic pressures +++ Medications ++ Mannitol at initial identification of hydrocephalus ++ To emergency room to assessment and management of medical emergencyTo neurosurgeon for surgical evacuation of cerebellar hematomaTo physiatrist for specific rehabilitation; physiatrist will manage medications, symptoms, future needs if not managed by neurologistTo occupational therapist for ADL, fine-motor task retrainingTo speech/language pathologist for speech and swallowing impairmentsTo support groups for patients and caregiversTo case management or social work for coordination of care ++ ArousalCranial nerve integrityPeripheral nerve integrity GaitWheelchair mobilityBalanceStatic sitDynamic sitStatic standDynamic standMoving base of supportMuscle strength (appearance of weakness may be an issue of low tone)Muscle recruitmentCoordinationPostural controlPostureReflexes... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth