Cerebellar stroke

Jensen MB, St. Louis EK. Management of acute cerebellar stroke. Arch Neurol 2005 62 537-544. 

FIGURE 8.3 Massive cerebellar stroke with herniation. 

Cerebellar strokes can be mild, with sudden vertigo, nausea, imbalance, and horizontal nystagmus, which soon recovers. They are frequently misdiagnosed as labyrinthitis. More... 

Fig. 11.3. Later ischemic change with hypodensity indicating a cerebellar stroke.

Moxifloxacin-induced rhabdomyolysis was reported in an elderly female admitted to ICU following a left cerebellar stroke. A urinary tract infection was treated for 4 days with intravenous moxifloxacin (400 mg). She subsequently developed typical rhabdomyolysis symptoms including myalgia and dark-coloured urine. A serum creatinine phos-phokinase measured 61,000 U/L. Cessation of the antibiotic and alkaline diuresis resolves the problem [59 ]. 

Tohgi H, Takahashi S, Chiba K, Hirata Y. Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. The Tohoku Cerebellar Infarction Study Group. Stroke 1993 24 1697-1701. 

Tulyapronchote R, Malkoff MD, Selhorst JB, Gomez CR. Treatment of cerebellar infarction by decompression suboccipital craniectomy. Stroke 1993 24 478 80. 

Koh MG, Phan TG, Atkinson JL, Wijdicks EFM. Neuroimaging in deteriorating patients with cerebellar infarcts and mass effect. Stroke 2000 31(9) 2062-2067. 

The most common causes of continuous central vertigo are medication, brain damages due to stroke or dementia, cerebellar atrophy and psychological reactions. It can also be a symptom of general cerebral ischemia due to hypotension, medication or cardiac arrhythmia. 

Amarenco P, Hauw JJ (1990) Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. A clinico-pathological study of 20 cases. Brain 113 139-155 Baquis GD, Pessin MS, Scott RM (1985) Limb shaking - a carotid TIA. Stroke 16 444-448 Barth A, Bogousslavsky J, Regli F (1994) Infarcts in the territory of the lateral branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 57 1073-1076 Baumgartner RW, Sidler C, Mosso M et al (2003) Ischemic lacunar stroke in patients with and without potential mechanism other than small-artery disease. Stroke 34 653-659... 

Besides the variable functional outcome after ischemia in animal models, it is well established that specific neuronal populations within an individual vary substantially in ischemic tolerance. Neurons in the CA1 region of the hippocampus and other distinct cellular populations of the caudate, thalamus, neocortex and cerebellum are selectively vulnerable to relatively brief periods of ischemia (Kirino and Sano 1984 Siesjo 1988). The reasons for this phenomenon are not fully elucidated, but for example in cerebellar Purkinje cells it could be shown that a reduced level of aldolase may trigger energy failure after brief periods of anoxia (Welsh et al. 2002). Changes in microcirculation, as seen in focal stroke,... 

Fig. 7.2. A patient presenting with atrial fibrillation and a transient ischemic attack was found to have a cerebellar microbleed on gradient echo MRI (a) and was started on stroke prevention with aspirin rather than warfarin. Six months later, this patient had a symptomatic hemorrhage at the same site (b).

Schwartz NE, Venkat C, Albers GW (2007). Transient isolated vertigo secondary to an acute stroke of the cerebellar nodulus. Archives of Neurology 64 897 Sedlaczek O, Hirsch JG, Grips E et al. 

Subarachnoid hemorrhage Acute painful neck conditions Meningitis/encephalitis Cerebellar/brainstem stroke Intraventricular hemorrhage Recent head injury Migraine... 

Fatal cerebellar infarction has been described in a 39-year-old man who took sumatriptan 100 mg for an acute attack of migraine. The cerebellar infarct was diagnosed at autopsy, and intracranial vasospasm was thought to be the likely mechanism (18). It should be noted that stroke has also been documented in patients with migraine, independently of drug treatment. 

In normal human subjects the agent allowed an excellent delineation of the cortical gray matter, the basal ganglia, the thalamus and cerebellar hemispheres as regions of relatively increased tracer uptake. White matter displayed substantially less uptake than gray matter. The primary route of excretion of the tracer is through the kidneys. TcO-L.L-E( ID I" SPECr shows particular promise for the evaluation of patients with stroke [ 70],... 

Lysko, P.G., Webb, C.L., Yue, T.L., Gu, J.L., and Feuerstein, G. 1994. Neuroprotective effects of tetrodotoxin as a Na channel modulator and glutamate release inhibitor in cultured rat cerebellar neurons and in gerbil global brain ischemia. Stroke 25, 2476-2482. 

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