Cerebellar Stroke

(Stroke, Cerebellar)

Definition

The cerebellum is located in the lower part of the brain, towards the back. This part of the brain plays a role in body movement, eye movement, and balance.

A cerebellar stroke occurs when the brain’s blood supply to this area is interrupted. Without blood, the brain tissue quickly dies. This results in the loss of certain functions. A stroke is a serious condition that needs emergency care.

Cerebellum

There are two main types of stroke ischemic and hemorrhagic. An ischemic stroke is the most common type of stroke.

Causes

An ischemic stroke is caused by a blockage of the blood flow, which may be due to:

A clot from another part of the body like the heart or neck. The clot breaks off and flows through the blood until it becomes trapped in a blood vessel supplying the brain.
A clot that forms in an artery that supplies blood to the brain.
A tear in an artery supplying blood to the brain. Called an arterial dissection.

A hemorrhagic stroke is caused by a burst blood vessel. Blood spills out of the broken blood vessel and pools in the brain. This interupts the flow of blood and causes a build up of pressure on the brain.

Risk Factors

Factors that may increase your risk of stroke include:

Sex: Men are more likely to have strokes than women but women are more likely to die of strokes than men
African American, Hispanic or Asian/Pacific Islander descent
Age: Risk of stroke increases with age particularly after 55 years of age.
Family history of stroke

Medical conditions that can increase your risk of stroke include:

High blood pressure (the number one risk factor for ischemic stroke)
High blood homocysteine level
Atherosclerosis
High cholesterol levels —specifically high-LDL "bad" cholesterol
Diabetes mellitus or impaired glucose tolerance
Atrial fibrillation
Blood disorders such as sickle cell disease and polycythemia
Disease of heart valves, such as mitral stenosis
Prior stroke or cardiovascular disease, such as heart attack
Peripheral artery disease
Transient ischemic attack (TIA) —a "warning stroke" with stroke-like symptoms that go away shortly after they appear
Conditions that increase your risk of blood clots such as:
- Cancer
- Pregnancy
- Certain autoimmune diseases
Having a blood vessel abnormality

Lifestyle factors that can increase your risk of stroke include:

Drug abuse (heroin, cocaine , amphetamines)
Smoking
Use of birth control pills , especially if you are over 35 years old and smoke
Long-term use of hormone replacement therapy
Physical inactivity
Alcohol abuse

Symptoms

Symptoms of a cerebellar stroke come on suddenly and may include:

Uncoordinated movements of the limbs or trunk (ataxia)
Difficulty walking, including problems with balance
Abnormal reflexes
Tremors
Vertigo (feeling of spinning or whirling when you are not moving)
Nausea and vomiting
Intense headache
Speech problems and difficulty swallowing
Problems sensing pain and temperature
Difficulty hearing
Problems with vision (eg, eyes move rapidly, difficulty controlling eye movement)
Problems with eyes (eg, small pupil, droopy eyelid)
Loss of consciousness

If you or someone you know has any of these symptoms, call for medical help right away. Brain tissue without blood flow dies quickly.

Diagnosis

The doctor will do a physical exam and look for muscle weakness, visual and speech problems, and movement difficulty. If possible, you will be asked about your symptoms and medical history. Your doctor may use a CT scan or MRI scan of the brain to confirm a stroke or rule out other conditions.

Your doctor may also order tests that create detailed images of blood vessels. These test will help see which blood vessels may be creating the problem:

Magnetic resonance angiography (MRA) —maps blood flow
CT angiogram (CTA)—creates detailed images of the blood vessels and their blood flow
Doppler ultrasound —evaluates flow of blood in the head and neck

Blood tests can also help identify clotting problems in the blood. Your doctor may also examine the fluid that surrounds your brain and spine.

Treatment

Immediate treatment is needed to:

Dissolve or remove a clot (for ischemic stroke)
Stop bleeding (for hemorrhagic stroke)

Medications

For an ischemic stroke, the doctor may give medications to:

Dissolve clots and/or prevent new ones from forming
Thin blood
Control blood pressure
Reduce brain swelling
Treat an irregular heart rate

For a hemorrhagic stroke, the doctor may give medicines to:

Work against any blood-thinning drugs you were taking before the stroke
Reduce how your brain reacts to bleeding
Control blood pressure
Prevent seizures

Surgery

For an ischemic stroke, the doctor may do surgery to:

Reroute blood supply around a blocked artery
Remove fatty deposits from a carotid artery ( carotid artery endarterectomy )
Widen and keep open a carotid artery ( angioplasty and stenting )
Remove the clot or deliver clot-dissolving medicine

A catheter may also be passed through the blood vessels to the blocked area. The catheter can help remove the clot or deliver medicine directly to the area.

For a hemorrhagic stroke, the doctor may:

Remove a piece of the skull to relieve pressure on the brain ( craniotomy )
Place a clip or a tiny coil in an aneurysm to stop it from bleeding

Rehabilitation

A rehabilitation program focuses on:

Physical therapy—to regain as much movement as possible
Occupational therapy—to assist in everyday tasks and self-care
Speech therapy—to improve swallowing and speech challenges
Psychological therapy—to improve mood and decrease depression

Prevention

Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:

Exercise regularly.
Eat more fruits, vegetables , and whole grains . Limit dietary salt and fat .
Stop smoking .
Increase your consumption of fish.
Drink alcohol only in moderation (1-2 drinks per day).
Maintain a healthy weight.
Check blood pressure frequently . Follow your doctor's recommendations for keeping it in a safe range.
Take aspirin if your doctor says it is safe.
Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
Talk to your doctor about the use of a statins. These types of drugs may help prevent certain kinds of strokes in some people.
Seek medical care if you have symptoms of a stroke, even if symptoms stop.
Stop the use of recreational drugs (eg, cocaine, heroin, amphetamines).

RESOURCES

American Heart Association http://www.americanheart.org

National Stroke Association http://www.stroke.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca

References

Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke . 2010 October 21. Available at: http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3181f7d043v1 . Updated October 21, 2010. Accessed September 4, 2012.

Hemorrhagic stroke. American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds%5FUCM%5F310940%5FArticle.jsp . Accessed June 6, 2013.

Hemorrhagic stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=HEMSTROKE . A Accessed September 4, 2012.

Intracerebral hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 21, 2013. Accessed June 6, 2013.

Ischemic stroke. American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots%5FUCM%5F310939%5FArticle.jsp . Accessed June 6, 2013.

Long term management of stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 30, 2013. Accessed June 6, 2013.

Stroke (acute management). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 2, 2013. Accessed June 6, 2013.

Nueroimaging for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 15, 2013. Accessed June 6, 2013.

Signs and symptoms. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SYMP . A Accessed September 4, 2012.

Stroke (acute management). EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 30, 2012. Accessed September 4, 2012.

Subarachnoid hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 22, 2013. Accessed June 6, 2013.

Jensen M, St. Louis E. Management of acute cerebellar stroke. Archives of Neurology website. Available at: http://archneur.ama-assn.org/cgi/reprint/62/4/537.pdf . Published April 2005. Accessed June 11, 2013.

Revision Information

Reviewer: Rimas Lukas, MD
Review Date: 05/2013 -
Update Date: 06/11/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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