Cerebellar Stroke
Cerebellar infarction and hemorrhage share symptoms and signs according to the cerebellar structures affected. Although the clinical features of isolated cerebellar infarction are similar across the three main cerebellar vascular territories, dysarthria i
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Keun-Hwa Jung and Jae-Kyu Roh
Abstract
Cerebellar infarction and hemorrhage share symptoms and signs according to the cerebellar structures affected. Although the clinical features of isolated cerebellar infarction are similar across the three main cerebellar vascular territories, dysarthria is most likely to be associated with lesions in the territory of the superior cerebellar artery, whereas vertigo and lateropulsion appear to be more often seen in lesions involving the territory of the posterior inferior cerebellar artery. Audio-vestibular symptoms are characteristic in lesions in the anterior inferior cerebellar artery territory. The main etiologies of cerebellar stroke are artery-to-artery embolism and cardioembolism, followed by in situ branch atherosclerosis. The increasing availability of MRI and advent of new imaging techniques prompt us to better define the cerebellar stroke syndromes and identify the mechanism of stroke. Acute cerebellar stroke requires constant vigilance by clinicians owing to often rapid clinical deterioration. This deterioration results from brainstem compression by mass effect, evolving hydrocephalus, or irreversible brainstem infarction. Medical therapy, vascular procedures, or surgical interventions can improve patients’ outcomes. The chapter reviews cerebellar stroke, from clinical features to the mechanism, potential complications, diagnosis, and treatment of patients.
Introduction Cerebellar infarction accounts for 2–10% of cases in clinical series of cerebral infarctions (Bogousslavsky et al. 1988; Amarenco 1991; Tohgi et al. 1993;
K.-H. Jung • J.-K. Roh (*) Department of Neurology, Seoul National University, Medical College, Seoul National University Hospital, 28, Yongon-dong, Chongro-gu, Seoul 110-744, South Korea e-mail: [email protected], [email protected], [email protected] M. Manto, D.L. Gruol, J.D. Schmahmann, N. Koibuchi, F. Rossi (eds.), 1959 Handbook of the Cerebellum and Cerebellar Disorders, DOI 10.1007/978-94-007-1333-8_90, # Springer Science+Business Media Dordrecht 2013
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K.-H. Jung and J.-K. Roh
Amarenco et al. 1994). Although the incidence of cerebellar infarcts has increased along with the improvement of brain imaging techniques, the majority of cerebellar infarcts have a benign clinical course. The hydrocephalus and brainstem compression resulting from post-infarct edema are associated with a high morbidity and mortality, but remain relatively rare (Kase et al. 1993; Chaves et al. 1994). The mean age of patients is 60–70 years and about two thirds of patients are men (Macdonell et al. 1987; Tohgi et al. 1993). As the population of developed countries becomes older, the incidence of cerebellar infarction is expected to rise. Overall, the infarction in posterior inferior cerebellar arteries (PICA) territory is more common than that in the superior cerebellar arteries (SCA), and anterior inferior cerebellar artery (AICA) infarction is the least common (Macdonell et al. 1987; Kase et al. 1993; Tohgi et al. 1993; Kumral et al. 2005a, b, 2006). In the
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