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 Artery||Anterior Inferior Cerebellar Artery||Superior Cerebellar Artery|
|Origin||Vertebral artery||Proximal or midbasilar artery||Distal basilar artery|
|Key brain stem structures affected||Posterolateral medulla||Posterolateral pons||Posterolateral midbrain|
|Inferior cerebellar peduncle||Middle cerebellar peduncle||Superior cerebellar peduncle|
|Key cerebellar structures affected||Posteroinferior cerebellum||Anteroinferior cerebellum||Superior cerebellum|
|Inner ear (labyrinth, cochlea)|
|Major features||Isolated acute vestibular syndrome without auditory symptoms||Isolated acute vestibular syndrome with auditory symptoms||Acute gait or trunk instability with dysarthria, nausea, vomiting|
|Neurologic signs||Lateral 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)|
Edlow JA, Newman-Toker DE, Savitz SI: Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7:951-964, 2008.