Diagnosis | Cerebellar infarction

Diagnosis

The first priority in diagnostics is the physical and neurological examination to identify the infarction itself. The neurological deficits can be of various kinds, but in the case of a cerebellar infarction they concentrate on the sense of balance, as well as the coordination and execution of movement sequences. If a cerebellar infarction is suspected, it should be determined immediately whether it is due to an occlusion or bleeding.

A cCT (computed tomography of the head) is usually performed for this purpose. If the image shows bright (hyperdense) areas, it is a bleeding. If the cCT is initially inconspicuous, an occlusion can be assumed and should be treated immediately with lysis therapy (dissolution of the clot) if no more than 4.5 hours have elapsed since the first appearance of the symptoms.

Alternatively, an MRI of the brain (magnetic resonance imaging) can be performed. This shows early signs of an infarction, such as the swelling around the infarcted area (perifocal edema). In addition, a so-called perfusion-diffusion mismatch can be used in the MRI to find out in which regions of the brain the blood supply is disturbed, or which parts are most likely to have been irreversibly destroyed. To find out the cause of the stroke – where, for example, the clot came from – the heart and the neck vessels are examined with ultrasound.

Therapy

The type of treatment is determined by the type of infarction. If bleeding is the cause of the cerebellar infarction, the patient must first be monitored by intensive care medicine. Blood clotting must be controlled, pain must be treated and blood pressure must be adjusted.

Careful attention must be paid to signs of cerebral pressure (nausea, disturbances of consciousness) in order to be able to recognize and treat them early. For each individual case, it must be decided whether surgical opening of the skull is necessary to relieve pressure. If a vascular occlusion is the cause of the stroke, quick action must be taken.Up to 4.5 hours after the first appearance of symptoms, a venous lysis therapy can be started to dissolve the fixed clot.

A maximum of 6 hours may pass if lysis is performed via the arterial route or mechanical removal of the clot by catheter. No lysis therapy at all may be used in patients with disturbed coagulation, bleeding or severe high blood pressure, after surgery, in pregnancy or in cases of bacterial inflammation of the heart valves. In addition to acute therapy, basic care should also be provided.

A sufficient supply of oxygen, a stable circulation and the monitoring of the cerebral pressure are essential. If there is mild hypertension, it should be maintained when cerebral hemorrhage is ruled out in order to improve the blood supply to the damaged brain tissue. Fever and blood sugar controls are also part of the necessary monitoring measures.