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Cerebellar Stroke

(Stroke, Cerebellar)

Definition

The cerebellum is the lower part of the brain. It sits towards the back. This part of the brain helps with body movement, eye movement, and balance.

A cerebellar stroke happens when the blood supply to the left side of the brain is interrupted. Blood brings oxygen and nutrients to brain tissue. When blood flow is stopped, the brain tissue quickly dies.

Cerebellum
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There are 2 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. It breaks off and flows in the blood through the body. The clot then 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. Known as 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. It also causes a buildup of pressure on the brain.

Risk Factors

Some 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 issues can increase your risk of stroke. Management or prevention of these conditions can significantly decrease your risk of stroke. Medical conditions include:

Risk factors specific to women include:

Symptoms

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

  • Uncoordinated movements of the limbs or trunk
  • 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, like eyes move rapidly or difficulty controlling eye movement
  • Problems with eyes, like small pupils or droopy eyelids
  • 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. The doctor will look for muscle weakness, and problems with movement. Vision and speech will also be checked. If possible, you will be asked about your symptoms and past health.

Images may be taken of the brain. This can be done with:

Blood tests will show if there is a problem with blood clotting.

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 medicine 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 medicine 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 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 no more than 1 drink per day for women and 2 drinks per day for men.
  • 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.
RESOURCES:

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

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

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Heart and Stroke Foundation
http://www.heartandstroke.com

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. 2011;42(1):227-276.

Hemorrhagic stroke. National Stroke Association website. Available at: http://www.stroke.org/understand-stroke/what-stroke/hemorrhagic-stroke. Accessed November 8, 2018.

Hemorrhagic strokes (bleeds). American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds_UCM_310940_Article.jsp#.Vk3h_k2FPIU. Updated April 26, 2017. AAccessed November 8, 2018.

Intracerebral hemorrhage. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115590/Intracerebral-hemorrhage. Updated November 28, 2018. Accessed December 11, 2018.

Ischemic strokes (clots). American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp#.Vk3ipE2FPIU. Updated August 26, 2017. Accessed November 8, 2018.

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Neuroimaging for acute stroke. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T474350/Neuroimaging-for-acute-stroke. Updated April 13, 2018. Accessed December 11, 2018.

Stroke (acute management). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T143427/Stroke-acute-management. Updated November 27, 2018. Accessed December 11, 2018.

Subarachnoid hemorrhage. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116453/Subarachnoid-hemorrhage. Updated June 6, 2018. Accessed December 11, 2018.

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Last reviewed November 2018 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 12/11/2018