Cerebellar stroke syndrome

Overview

Cerebellar stroke syndrome refers to a group of neurological symptoms resulting from a stroke occurring in the cerebellum — the part of the brain responsible for coordinating voluntary movements, balance, and posture. Although cerebellar strokes are less common than strokes in other parts of the brain, they can be particularly dangerous due to the risk of brain swelling and compression of vital structures. Early recognition and prompt treatment are crucial to reduce the risk of serious complications and long-term disability.

Causes

Cerebellar strokes can be caused by either a blockage of blood flow (ischemic stroke) or bleeding into the cerebellum (hemorrhagic stroke). Common causes include:

• Ischemic stroke: Caused by blockage of the arteries supplying the cerebellum, such as the posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), or superior cerebellar artery (SCA)

• Hemorrhagic stroke: Due to rupture of blood vessels in the cerebellum, often from uncontrolled hypertension or aneurysms

• Embolism: Clots from the heart or larger arteries that travel to cerebellar vessels

• Atherosclerosis: Narrowing of arteries due to plaque buildup

• Trauma: In rare cases, head injury can lead to cerebellar bleeding

Symptoms

Symptoms of cerebellar stroke vary depending on the size and location of the stroke, but they generally involve problems with coordination and balance. Common symptoms include:

• Vertigo: A spinning sensation, often with nausea and vomiting

• Ataxia: Loss of coordination in the arms or legs, resulting in clumsy or unsteady movements

• Gait instability: Difficulty walking or maintaining balance

• Dysarthria: Slurred or slowed speech

• Headache: Often sudden and severe, especially in hemorrhagic stroke

• Visual disturbances: Such as double vision or abnormal eye movements (nystagmus)

• Decreased level of consciousness: In severe cases due to swelling or brainstem compression

Symptoms can progress rapidly, and swelling in the cerebellum may compress the brainstem, leading to respiratory failure or death if not treated promptly.

Diagnosis

Timely diagnosis of cerebellar stroke is critical. The following diagnostic tools are commonly used:

• Neurological examination: To assess coordination, balance, eye movements, and speech

• Imaging:

  • CT scan: Often used in emergency settings to detect bleeding or swelling

  • MRI: More sensitive than CT for identifying ischemic strokes in the cerebellum

• CT angiography or MR angiography: To visualize blood vessels and identify blockages or aneurysms

• Cardiac evaluation: Including echocardiogram and ECG if an embolic source is suspected

• Blood tests: To evaluate clotting status, infection, or metabolic contributors

Treatment

Treatment of cerebellar stroke depends on the type (ischemic vs. hemorrhagic) and severity of the stroke. Key treatments include:

• For ischemic stroke:

  • Thrombolytic therapy: Intravenous tPA (tissue plasminogen activator) if administered within the appropriate time window

  • Mechanical thrombectomy: In select cases where a large clot is detected

  • Antiplatelet or anticoagulant therapy: Depending on the underlying cause

• For hemorrhagic stroke:

  • Blood pressure control and monitoring for increased intracranial pressure

  • Surgical decompression or evacuation of the hematoma in life-threatening cases

• Supportive care: Includes respiratory support, IV fluids, and prevention of complications like deep vein thrombosis or aspiration

• Rehabilitation: Physical, occupational, and speech therapy to regain function

Prognosis

The prognosis of cerebellar stroke depends on the size of the stroke, the presence of complications (such as swelling or brainstem compression), and the speed of treatment. Patients with small strokes and prompt treatment often recover well, while those with large strokes may face long-term disability or risk of death. Intensive rehabilitation can help many patients regain mobility and independence. Lifelong management may include stroke prevention strategies such as blood pressure control, smoking cessation, and use of antiplatelet medications.