Cerebellar stroke

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  • Sudden inability to walk is common finding
  • Can be confused w/ acute vestibular syndrome (e.g. labyrinthitis)
  • HINTS Exam can reliably distinguish the two (more effective than early DWI MRI)
    • 1. Head Impulse Testing
      • Tests vestibulo-ocular reflex
      • Have pt fix their eyes on your nose
      • Move their head in the horizontal plane to the left and right
      • If reflex is intact their eyes will stay fixed on your nose
      • If reflex is abnormal eyes will move with their head and won't stay fixed on your nose
      • It is reassuring if the reflex is abnormal!(due to dysfunction of the nerve)
    • 2. Nystagmus
      • Benign nystagmus only beats in one direction no matter which direction their eyes look
      • Bad nystagums beats in every direction their eyes look
        • If pt looks left, get left nystagmus, if looks right, get right-beating nystagmus
    • 3. Test of Skew
      • Vertical dysconjugate gaze is bad
      • Alternating cover test
        • Have pt look at your nose w/ their eyes and then cover one eye
          • When rapidly uncover the eye look to see if the eye quickly moves to re-align
    • If any of the above 3 tests are consistent w/ CVA obtain full work-up (including MRI)