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]

• 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]

• 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]

• 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]

• 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]

  They frequently present with headache, nausea and vomiting, dizziness, and a striking difficulty standing or walking. [medlink.com]

• 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]

  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]

• 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]

  IMMUNE-MEDIATED CAUSES OF ACUTE CEREBELLAR ATAXIA Immune-mediated ataxias may cause acute, subacute or chronic ataxia. [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]

  Limb ataxia Lesions of the cerebellar hemisphere cause ipsilateral signs. [patient.info]

• 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]

  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]

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

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]

• 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]

Edaravone, a free radical scavenger, may be useful in the treatment of vertigo and SNHL. [ncbi.nlm.nih.gov]

Clinical outcome following surgical treatment for bilateral cerebellar infarction. Acta neurologica Scandinavica 2011;123:345-351. 26. Mendelow AD, Gregson BA, Fernandes HM, et al. [degruyter.com]

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

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. [elsevier.es]

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]

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 [symptoma.com]

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]

Anatomical Distribution Superior cerebellar artery territory (SCA) – middle region Anterior inferior cerebellar artery territory (AICA) – middle region Posterior inferior cerebellar artery (PICA) – proximal region Epidemiology and Demographics Infarcts [wikidoc.org]

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]

SUMMARY: We first briefly review the clinical presentation of cerebellar infarctions, followed by a short refresher on cerebellar anatomy and pathophysiological mechanisms of cerebellar infarcts. [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]

Stent-assisted angioplasty of the right VA was performed to prevent recurrence of the cerebellar infarction. Post-procedure, the neuropsychology tests showed cognitive improvement to MMSE score of 26 and WAIS-R score of 84. [ncbi.nlm.nih.gov]

Stay up to date on hot topics such as mechanisms of action of commonly used drugs, neuronal angiogenesis and stem cells, basic mechanisms of spasm and hemorrhage, prevention of stroke, genetics/predisposing risk factors, and much more. [books.google.com]

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7. Byrne JV. The aneurysm "clip or coil" debate. Acta Neurochir (Wien). 2006 Feb. 148(2):115-20.
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