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Cerebellar Stroke

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.

Cerebellum
IMAGE
Copyright © Nucleus Medical Media, Inc.

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. This is 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 interrupts the flow of blood and causes a build up of pressure on the brain.

Risk Factors

Certain factors increase your risk of stroke but can not be changed, such as:

  • Race—People of African American, Hispanic, or Asian/Pacific Islander descent are at increased risk.
  • Age: Older than 55 years of age
  • Family history of stroke

Other factors that may increase your risk can be changed such as:

Certain medical condition that can increase your risk of stroke. Management or prevention of these conditions can significantly decrease your risk. Medical conditions include:

Risk factors specific to women include:

  • Previous pre-eclampsia
  • Use of birth control pills, especially if you are over 35 years old and smoke
  • Long-term use of hormone replacement therapy
  • Menopause
  • Pregnancy—due to increased risk of blood clots

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—a 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 emergency medical services right away. Brain tissue without blood flow dies quickly. Early care can decrease damage.

Diagnosis

A physical exam will be done to look for muscle weakness, visual and speech problems, and movement difficulty. If possible, you will be asked about your symptoms and medical history.

Images may be taken of your bodily structures. This can be done with:

Blood tests can also help identify clotting problems in the blood. The fluid that surrounds your brain and spine may be examined.

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 medications 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 medication

A catheter may also be passed through the blood vessels to the blocked area. The catheter can help remove the clot or deliver medication 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 .
  • If you smoke, talk to your doctor about ways to quit.
  • Increase your consumption of fish.
  • Drink alcohol only in moderation. This means 1-2 drinks per day.
  • Maintain a healthy weight.
  • Check your 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 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.
  • If you use drugs, talk to your doctor about rehabilitation programs.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 11/2014 -
  • Update Date: 06/02/2014 -
  • American Heart Association

    http://www.heart.org

  • National Stroke Association

    http://www.stroke.org

  • Health Canada

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

  • Heart and Stroke Foundation

    http://www.heartandstroke.com

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  • Hemorrhagic stroke. National Stroke Association website. Available at: http://www.stroke.org/understand-stroke/what-stroke/hemorrhagic-stroke. Accessed November 18, 2014.

  • Hemorrhagic strokes (bleeds). American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds%5FUCM%5F310940%5FArticle.jsp. Updated September 16, 2014. Accessed November 18, 2014.

  • Intracerebral hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 6, 2014. Accessed November 18, 2014.

  • Ischemic strokes (clots). American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots%5FUCM%5F310939%5FArticle.jsp. Updated August 29, 2014. Accessed November 18, 2014.

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  • Long term management of stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 30, 2014. Accessed November 18, 2014.

  • Nueroimaging for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 14, 2014. Accessed November 18, 2014.

  • Recognizing stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SYMP. Accessed November 18, 2014.

  • Stroke (acute management). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 17, 2014. Accessed November 18, 2014.

  • Subarachnoid hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 28, 2014. Accessed November 18, 2014.

  • 2/7/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: Bushnell C, et al. AHA/ASA Guideline for the Prevention of Stroke in Women. Stroke. 2014 Feb 6. [Epub ahead of print]

  • 6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Myint PK, Cleark AB, et al. Bone mineral density and incidence of stroke: European prospective investigation into cancer-norfolk population-based study, systemic review, and meta-analysis. Stroke. 2014 Feb;45(2):373-82.

  • 6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Imfeld P, Bodmer M, et al. Risk of incident stroke in patients with Alzheimer disease or vascular dementia. Neurology. 2013 Sep 3;81(10):910-919.