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Cerebellar Stroke(Stroke, Cerebellar)
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. A stroke is a serious condition that needs emergency care.

Cerebellum

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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. 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 interupts 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 (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

The doctor will do a physical exam and look for muscle weakness, visual and speech problems, and movement difficulty. If possible, you will be asked about your symptoms and medical history. Your doctor may use a CT scan or MRI scan of the brain to confirm a stroke or rule out other conditions.

Your doctor may also order tests that create detailed images of blood vessels. These test will help see which blood vessels may be creating the problem:

Blood tests can also help identify clotting problems in the blood. Your doctor may also examine the fluid that surrounds your brain and spine.

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 medicines 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 medicine

A catheter may also be passed through the blood vessels to the blocked area. The catheter can help remove the clot or deliver medicine 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 .
  • Stop smoking .
  • Increase your consumption of fish.
  • Drink alcohol only in moderation (1-2 drinks per day).
  • Maintain a healthy weight.
  • Check 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 a 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.
  • Stop the use of recreational drugs (eg, cocaine, heroin, amphetamines).

RESOURCES:

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

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

CANADIAN RESOURCES:

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

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

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 . 2010 October 21. Available at: http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3181f7d043v1 . Updated October 21, 2010. Accessed September 4, 2012.

Hemorrhagic stroke. American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds_UCM_310940_Article.jsp . Accessed June 6, 2013.

Hemorrhagic stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=HEMSTROKE . A Accessed September 4, 2012.

Intracerebral hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 21, 2013. Accessed June 6, 2013.

Ischemic stroke. American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp . Accessed June 6, 2013.

Long term management of stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 30, 2013. Accessed June 6, 2013.

Stroke (acute management). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 2, 2013. Accessed June 6, 2013.

Nueroimaging for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 15, 2013. Accessed June 6, 2013.

Signs and symptoms. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SYMP . A Accessed September 4, 2012.

Stroke (acute management). EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 30, 2012. Accessed September 4, 2012.

Subarachnoid hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 22, 2013. Accessed June 6, 2013.

Jensen M, St. Louis E. Management of acute cerebellar stroke. Archives of Neurology website. Available at: http://archneur.ama-assn.org/cgi/reprint/62/4/537.pdf . Published April 2005. Accessed June 11, 2013.

2/7/2014 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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.



Last reviewed December 2013 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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