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]

• Pallor

  Microscopical examination in the first 24 to 48 hours reveals anoxic neurons, pallor of staining and vacuolization of the white matter due to unraveling of myelin, and axonal swellings. [neuropathology-web.org]

  Drowsiness, irritability, apathy, pallor, vomiting or tortipelvis may also occur during the episodes. The etiology of benign paroxysmal torticollis is unknown. [scielo.br]

• Surgical Procedure

  Alternatively air may enter during certain surgical procedures especially neurosurgical procedures in sitting position (cervical disc and posterior fossa tumor surgeries),[ 2 ] laparoscopic surgeries and cardiothoracic surgery. [ncbi.nlm.nih.gov]

• Vomiting

  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]

  Introduction An 80-year-old woman was admitted for lethargy and vomiting after diagnostic cardiac catheterization. [ahajournals.org]

• Nausea

  A 41-yr-old man developed acute vertigo, disequilibrium, nausea, and headache, with progressive slow symptomatic improvement, and presented to medical attention 4 d after symptom onset. [ncbi.nlm.nih.gov]

• Suggestibility

  This suggests that impairment of a neural integrator may still exist. [ncbi.nlm.nih.gov]

  Initial CT brain suggested SAH with hydrocephalus. Subsequent cerebral angiography was negative. [scholars.northwestern.edu]

• Ataxia

  The most common clinical finding was severe gait ataxia with sudden falling (n = 9) or severe veering (n = 2). Cerebellar dysarthria was found in 8 patients. Eight patients had a mild unilateral limb ataxia. [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]

• Dysarthria

  Cerebellar dysarthria was found in 8 patients. Eight patients had a mild unilateral limb ataxia. These findings emphasize that MSCA territory cerebellar infarction presented with the prominent gait ataxia and cerebellar dysarthria. [ncbi.nlm.nih.gov]

• Nystagmus

  In most (82%, 9/11) patients with SN or GEN, the nystagmus subsided within 1 week after hospitalisation. DISCUSSION: Vertigo and nystagmus in SCA territory cerebellar infarction are more common than previously thought. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

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

  It is a pure cerebellar syndrome with normal or abnormal brain magnetic resonance imaging (MRI) at onset. [scielo.br]

• Gliosis

  Finally, large and small cerebellar infarcts tend to heal with cavitation, leaving a CSF-filled cavity surrounded by a rim of gliosis.10 Small cerebellar infarcts are often only detected as an incidental (cerebellar cortical) infarct cavity, which are [radiopaedia.org]

  […] blurring of anatomic detail; ii) subacute (1 week – 1 month) – there is obvious tissue destruction and liquefactive necrosis of the involved brain; iii) chronic (>1 month) – the damaged tissue has been phagocytized and there is cavition with surrounding gliosis [strokecenter.org]

  Nevertheless, if present, a hypo-intense (fluid-filled) cavity with a hyperintense rim on FLAIR is diagnostic of cavitation with surrounding gliosis (Fig. 7 b) [ 4, 5 ]. [karger.com]

  […] studies using cerebrospinal fluid (CSF)/plasma albumin ratio 37 and MRI. 38–41 It is hypothesised that the disrupted BBB would result in leakage of fluid, plasma components and cells and eventually lead to perivascular inflammation, demyelination and gliosis [svn.bmj.com]

  In a few weeks to months, gliosis develops, with a resultant increase in the quantity of extracellular water (, 45,, 51 ). [pubs.rsna.org]

Timely escalation of treatment is crucial and should be guided by clinical and neuroradiological rationales. [ncbi.nlm.nih.gov]

Though the prognosis is usually considered good, our patient made poor recovery. [ncbi.nlm.nih.gov]

Strangely enough, the development of complications did not serve to worsen patient prognosis; prognosis mainly depended on the number of affected territories and the presence of brainstem impairment.Conflicts of interest The authors have no conflicts [elsevier.es]

Prognosis correlates to a large extent with the size of infarct. [wikidoc.org]

We report a case of cerebellar infarction after repeated sports-related minor head injuries in a young adult and discuss the etiology. [ncbi.nlm.nih.gov]

Stroke, 3 1, str. 2062-7 [ EČ ][ GS ] Kumral, E., Kisabay, A., Atac, C. (2005) Lesion patterns and etiology of ischemia in superior cerebellar artery territory infarcts. [scindeks.ceon.rs]

Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., INFARCTION, ANTERIOR CEREBRAL ARTERY), and etiology (e.g., embolic infarction). [sideeffects.embl.de]

METHODS: The writing group used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion [ncbi.nlm.nih.gov]

Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care REFERENCE: "Etiology, classification, and epidemiology of stroke" UpToDate.com Reviewed on 9/5/2017 [medicinenet.com]

Please refer to the article on cerebral sinus thrombosis for a general discussion on epidemiology and risk factors. Other causes of venous occlusion should also be considered ( dural AVF, trauma, ligation). [radiopaedia.org]

We propose using all available information by changing the primary analysis from a dichotomous (yes/no) endpoint to a traditional epidemiological endpoint of an incidence rate in the group randomized to transfusion to the incidence rate in the group randomized [clinicaltrials.gov]

Epidemiology of stroke. In: Ginsberg MD, Bogousslavsky J, editors. Cerebrovascular disease. Pathophysiology, diagnosis, and management. Malden: Blackwell Science, 1998;pp:834-49. Klausner HA, Lewandowski C. Infrecuent causes of stroke. [medigraphic.com]

Although a number of theories have been proposed, the exact pathophysiology of RCH remains incompletely understood. [ncbi.nlm.nih.gov]

Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke. [books.google.com]

Pathophysiology, diagnosis, and management. Malden: Blackwell Science, 1998;pp:834-49. Klausner HA, Lewandowski C. Infrecuent causes of stroke. Emerg Med Clin North Am 2002;20:657-70. Leys D, Bandu L, Henon H, Lucas C, et al. [medigraphic.com]

Group A (n=28) consists of those who underwent preventive SDC, and group B (n=56) consists of those who did not undergo preventive SDC. We analyzed and compared clinical outcomes between groups. [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.