Classic cerebellar stroke syndromes

What are the classic cerebellar stroke syndromes? 

The cerebellar stroke syndromes are described in the below table and are suggested by abrupt onset, nausea, and vomiting in the absence of other localizing symptoms (or disproportionate to amount of dizziness or vertigo), sudden/severe/sustained headache particularly with other neurologic symptoms, persistent dizziness (>24 hours) especially in association with sudden hearing loss, or cranial nerve dysfunction.

Physical examination features that should suggest cerebellar stroke include normal vestibulo-ocular reflexes, spontaneous nystagmus, skew deviation, severe difficulty or inability to stand or walk, or other localizing neurologic findings.

Cerebellar Stroke Syndromes

Posterior Inferior Cerebellar ArteryAnterior Inferior Cerebellar ArterySuperior Cerebellar Artery
OriginVertebral arteryProximal or midbasilar arteryDistal basilar artery
Key brain stem structures affectedPosterolateral medullaPosterolateral ponsPosterolateral midbrain
Inferior cerebellar peduncleMiddle cerebellar peduncleSuperior cerebellar peduncle
Key cerebellar structures affectedPosteroinferior cerebellumAnteroinferior cerebellumSuperior cerebellum
Inner ear (labyrinth, cochlea)
Major featuresIsolated acute vestibular syndrome without auditory symptomsIsolated acute vestibular syndrome with auditory symptomsAcute gait or trunk instability with dysarthria, nausea, vomiting
Neurologic signsLateral medullary syndrome (unilateral absent gag reflex; palatal palsy; vocal cord palsy; Horner’s syndrome; body hemianalgesia; limb hemiataxia; dysmetria)Lateral pontine syndrome (hemifacial sensory loss; lower motor neuron facial palsy; Horner’s syndrome; body hemianalgesia limb hemiataxia; dysmetria)Lateral midbrain syndrome (hemifacial sensory loss; Horner’s syndrome; body hemisensory loss; limb hemiataxia; dysmetria)

Sources

Edlow JA, Newman-Toker DE, Savitz SI: Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7:951-964, 2008.

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