The three major arteries of the cerebellum: the superior cerebellar artery (SCA), anterior inferior cerebellar artery(AICA), and the posterior inferior cerebellar artery (PICA).
Central vs. Peripheral Causes of Vertigo
||Sudden or slow
||Ill defined, less intense
|Aggravated by position/movement
||Horizontal and unidirectional
||Vertical and/or multidirectional
|Fatigue of symptoms/signs
||Does not occur
|Abnormal tympanic membrane
||Does not occur
Left sided cerebellar stroke due to occlusion of a vertebral artery.
- POC glucose
- In large ICH or stroke, may see deep TWI and prolong QT, occ ST changes
- Head CT (non-contrast)
- In ischemia stroke CT has sensitivity 42%, specificity 91%
- In acute ICH the sensitivity is 95-100%
- The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)
- Also consider:
- CTA brain and neck
- To check for large vessel occlusion for potential thrombectomy
- Determine if there is carotid stenosis that warrants endarterectomy urgently
- Pregnancy test
- CXR (if infection suspected)
- UA (if infection suspected)
- Utox (if ingestion suspected)
MR Imaging (for Rule-Out CVA or TIA)
- MRI Brain with DWI, ADC (without contrast) AND
- Cervical vascular imaging (ACEP Level B in patients with high short-term risk for stroke):
- MRA brain (without contrast) AND
- MRA neck (without contrast)
- May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)
EMCrit: Diagnosis of Posterior Stroke
- ↑ Mullins ME, Schaefer PW, Sorensen AG, Halpern EF, Ay H, He J, Koroshetz WJ, Gonzalez RG. CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology. 2002 Aug;224(2):353-60.
- ↑ Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354(4):387–396.
- ↑ Douglas VC, Johnston CM, Elkins J, et al. Head computed tomography findings predict short-term stroke risk after transient ischemic attack. Stroke. 2003;34:2894-2899.
- ↑ ACEP Clinical Policy: Suspected Transient Ischemic Attack full text
- ↑ Nederkoorn PJ, Mali WP, Eikelboom BC, et al. Preoperative diagnosis of carotid artery stenosis. Accuracy of noninvasive testing. Stroke. 2002;33:2003-2008.