Cerebellar stroke
Clinical Features
- 5 Ds of Posterior Circulation Stroke: Dizziness, Dysarthria, Dystaxia, Diplopia, Dysphagia
- Sudden inability to walk is common finding
- Can be confused w/ acute vestibular syndrome (e.g. labyrinthitis)
Exam
- 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
- Have pt look at your nose w/ their eyes and then cover one eye
- If any of the above 3 tests are consistent w/ CVA obtain full work-up (including MRI)
- 1. Head Impulse Testing
Work-Up
- Bedside glucose
- Bedside Hb (polycythemia)
- CBC
- Chemistry
- Coags
- Troponin
- ECG (esp A-fib)
- Head CT
- Primarily used to exclude intracranial bleeding, abscess, tumor, other stroke mimics
- Also consider:
- Pregnancy test
- CXR (if infection suspected)
- UA (if infection suspected)
- Utox (if ingestion suspected
Treatment
- Early neurosurgical consultation is needed (herniation may lead to rapid deterioration)
- See Stroke (Main)
- See Thrombolysis in Acute Ischemic Stroke (tPA)
- See Stroke syndromes