Stroke, cerebellar

• 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 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 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

Demographics

• Can occur in any age group, either gender

Signs and Symptoms

• Occipital headache
• Vertigo
• Vomiting
• Mild facial weakness
• Dysphagia
• Dysarthria
• Gait ataxia
• Asthenia
• Limb ataxia
• Asynergia
• Dyssynergia
• Dysmetria
• Dysdiadochokinesia
• Tremor
• Postural instability
• Hypotonia
• Nystagmus
• Titubation

Functional Implications

• 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

Possible Contributing Causes

• Hypertension (HTN)
• Arteriovenous malformation (AVM)
• Hyperlipidemia
• Obesity
• Smoking
• Sedentary lifestyle
• Peripheral vascular disease
• Birth trauma

Differential Diagnosis

• Transient ischemic attack (TIA)
• Hydrocephalus
• Cerebellar ataxia
• Cerebellar degeneration

Imaging

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

Diagnostic Procedures

• Neurovascular tests
  • Neck flexion for meningeal irritation
  • Palpation of arteries
  • Auscultation of heart and blood vessels
  • Ophthalmic pressures

Medications

• Mannitol at initial identification of hydrocephalus

• 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

• 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...