The symptoms of a cerebellar infarct clearly depict the region of the cerebellum that is subjected to ischemic damage. In addition to specific symptoms, there are other non-specific symptoms like headaches, dizziness, and vomiting.

A blockage of blood flow in the superior, anterior inferior or posterior inferior cerebellar arteries can result in a cerebellar infarction. The primary region affected is the brainstem, and, therefore, the symptoms clearly depict various degrees of damage to this anatomical structure. Symptoms typical of a cerebellar infarct include dysarthria, diplopia, muscle weakness, limb ataxia and isolated vertigo, usually constituting an occlusion of the posterior inferior cerebellar artery [1].

The symptomatology related to a cerebellar infarction tends to arise spontaneously and then progresses rapidly, while risk factors such as hypertension and cardiovascular disease usually complete the patient's background [2]. Profound ataxia, vertigo, and multidirectional nystagmus are three symptoms that raise considerable suspicion of a cerebellar infarction and should be investigated in depth since their misinterpretation lays the foundation for many cases of undiagnosed cerebellar infarctions [3].

Additionally, multidirectional nystagmus also referred to as gaze-evoked or direction-changing nystagmus, encompasses a change in the direction of nystagmus, depending on the direction of the patient's gaze. This symptom evinces a more than 50% sensitivity for the diagnosis of a cerebellar infarction [4]. In order to elicit an irrefutable gaze-evoked nystagmus sign, extreme lateral strain should be avoided [5]

• Falling

  […] and falling with OT and skew deviation if nodulus is infarcted. [ncbi.nlm.nih.gov]

  Gait imbalance usually sudden and severe; patients tend to fall toward the side of the cerebellar lesion (ipsilateral axial lateropulsion) Limb ataxia occurs in half (50%) Severe cerebellar mass effect in 30%, resulting in hydrocephalus in 20%, resulting [wikidoc.org]

• HELLP Syndrome

  HELLP syndrome may have contributed to the development of cerebellar infarction in the case. [ncbi.nlm.nih.gov]

• Walking with a Cane

  Vertigo gradually improved, and the patient was able to walk with a cane. Previously slurred speech was completely resolved. This case demonstrates that a Jefferson fracture can cause vertebral artery occlusion, resulting in cerebellar infarction. [ncbi.nlm.nih.gov]

• Joint Subluxation

  Atlantoaxial joint subluxation and vertical subluxation of the axis may occur as a consequence of instability resulting from the inflammatory process. [ncbi.nlm.nih.gov]

• Chancre

  The patient was diagnosed with neurosyphilis based on a history of chancre, positive serum and cerebrospinal serologies, cerebrospinal pleocytosis, and increased intrathecal immunoglobulin synthesis. [ncbi.nlm.nih.gov]

• Vertigo

  The patient's vertigo and hemiplegia improved completely after treatment. Case 2, a 50-year-old man who experienced sudden vertigo and sensorineural hearing loss (SNHL), developed dysarthria after admission. [ncbi.nlm.nih.gov]

• Dizziness

  In this report, we present a 55-year-old male who admitted to hospital with vomiting, nausea and dizziness. On examination left-sided hemiparesia and ataxic gait were detected. [ncbi.nlm.nih.gov]

• Nystagmus

  To define the characteristics and mechanism of head-shaking nystagmus in central vestibulopathies, we investigated spontaneous nystagmus and head-shaking nystagmus in 72 patients with isolated cerebellar infarction. [ncbi.nlm.nih.gov]

• Tremor

  Abstract We report a 67-year-old man who developed yes/yes head tremor without appendicular tremor six weeks after right occipital and bilateral cerebellar infarction. The tremor was resting-postural. [ncbi.nlm.nih.gov]

  Tremor Cerebellar lesions can produce unilateral or bilateral intention tremor, or a truncal tremor. Nausea and vomiting Cerebellar lesions can produce nausea and/or vomiting. [patient.info]

  Tremor: in volitional muscle contraction. – Positional postural action static (hands stretched out “stop” sign in volitional muscle contraction). [slideshare.net]

  Voogd and van Baaren, 2013 feel that palatal tremor is not a necessary part of Wernekinck, as other tracts are responsible for OPM. [dizziness-and-balance.com]

• Cerebellar Ataxia

  On neurological examination he had right cerebellar ataxia. Computed tomography and magnetic resonance imaging, revealed an acute right cerebellar infarction in the anterior inferior cerebellar artery territory. [ncbi.nlm.nih.gov]

  Table 1 The main group of diseases that may cause acute cerebellar ataxias. [scielo.br]

  But it can be seen in patients with cerebellar ataxia also. False-Positive Head-Impulse Test in Cerebellar Ataxia Abnormal Head Impulse Test in a Unilateral Cerebellar Lesion It’s explained by deficit in floccular function. [dusanpavlovic.com]

  Idiopathic cerebellar ataxia - a diagnosis of exclusion. Presentation As the cerebellum is associated with motor control, lesions produce a range of movement disorders (ataxias). These can be differentiated by their time course. [patient.info]

The workup involved in the investigation of a potential cerebellar infarction encompasses three vital steps: a thorough clinical examination, imaging modalities to confirm clinical suspicion and glucose testing, as well as, investigations to determine the possible cause, should it be unknown.

Initially, a cerebellar infarction caused by a thrombotic event is suspected when an acute neurologic impairment is observed corresponding to the arterial occlusion of a specific cerebellar artery. Non-specific symptoms, such as headaches, vomiting and coma/stupor are more indicative of a hemorrhagic event. A clinical diagnosis of the exact arterial branch that has been occlusion is often impossible, with the symptoms and progression being only indicative of the particular characteristics of each event.

Neuroimaging is an essential method to diagnose the infarction. A computerized tomography scan (CT scan) can detect the region of the arterial occlusion, but its sensitivity increases with the progression of the event [6]. It also constitutes a means to differentiate between a cerebellar infarction, a tumor, hemorrhage, subdural or epidural hematoma and is indicated in patients who require special equipment for monitoring and life support [7]. A magnetic resonance imaging scan (MRI) is able to detect an infarction earlier during the course and with greater sensitivity than a CT scan; small infarctions may even be detected solely by means of a magnetic resonance imaging scan (MRI scan). Diffusion-weighted imaging (DWI) is an extremely useful tool for the evaluation of patients with a transient ischemic attack [8].

In order to diagnose the etiology of the infarction, vascular, cardiac and hematological evaluation are carried out:

Possible cardiac pathology can be detected with an electrocardiogram, telemetry, serum troponin, Holter monitoring and an echocardiogram.

Investigations including a magnetic resonance angiography (MRA), a computerized tomography angiography, conventional angiography, carotid and transcranial duplex ultrasonography, can be performed in order to assess an underlying vascular pathology.

Disorders that affect the coagulation cascade can lead to a hypercoagulative disorder, that may lead to a thrombotic cerebellar infarction. Laboratory evaluation of the platelet count, a complete blood count and a PT/PTT measurement can provide the initial clues of a coagulation pathology. An accurate diagnosis will be established as soon as additional tests are performed, such as homocysteine, antithrombin III, factor V Leiden levels, as well as various other indicators.

• Brain MRI Abnormal

  Antibiotic-induced acute ataxia Weeks after initiation of metronidazole, an encephalopathy accompanied by cerebellar signs and brain MRI abnormalities may occur. [scielo.br]

• Wide QRS Complex

  The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. [ncbi.nlm.nih.gov]

1. Afifi AK, Bergman RA. Functional Neuroanatomy Text and Atlas. McGraw-Hill Companies 1998.
2. Tohgi H, Takahashi S, Chiba K, et al. Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. The Tohoku Cerebellar Infarction Study Group. Stroke. 1993;24:1697–701.
3. Hotson JR, Baloh RW. Acute vestibular syndrome. N Engl J Med. 1998;339:680–5.
4. Lee H, Sohn SI, Cho YW, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006;67:1178–83.
5. Leigh RJ, Rucker JC. Nystagmus and related ocular motility disorders. In: Miller NR, Newman NJ, editors. Walsh and Hoyt’s Clinical Neuro-Opthalmology. Baltimore, MD: Lippincott, Williams & Wilkins; 2004.
6. Shinichi N, Tsutomu I, Hirokazu K, Takumi Y, Tokuro I, Shinichiro W. Correlation of Early CT Signs in the Deep Middle Cerebral Artery Territories with Angiographically Confirmed Site of Arterial Occlusion. AJNR Am J Neuroradiol. 2001 Apr;22(4):654-9.
7. Byrne JV. The aneurysm "clip or coil" debate. Acta Neurochir (Wien). 2006 Feb. 148(2):115-20.
8. Sorensen AG, Buonanno FS, Gonzalez RG, et al. Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. Radiology. 1996 May; 199(2):391-401.