Cerebellar infarction, its consequences

Deputy chief physician for medical work, kmn, neurologist, doctor of physical and rehabilitation medicine

Kritskaya Olga Pavlovna

Neurologist, highest category

Maltseva Marina Arnoldovna

Neurologist, specialist in the field of extrapyramidal pathologies, doctor of the highest category

Shabunina Ekaterina Mikhailovna

Neurologist, category 2

Cerebellar stroke is one of the rarest types of ischemic stroke. It has been studied very little, so doctors experience great difficulty in making a correct diagnosis. It is also considered one of the most dangerous, since the lesion can be located very close to the trunk and other vital nerve centers of the human brain.

A cerebellar stroke may appear as a ruptured blood vessel or tissue death (necrosis). The mechanism of development is very similar to other types of intracerebral strokes. Thus, the causes of occurrence and subsequent symptoms may be identical. People over the age of 40 most often suffer from cerebellar stroke, and the highest percentage of damage is observed in men. Medical statistics indicate a high mortality rate among victims. However, a favorable outcome is still possible if first aid to the victim was provided on time.

About the disease

With this pathology, hemorrhage occurs in the cerebellum.
It is very difficult to predict such a stroke.

It happens, for the most part, suddenly and occurs within 2-3 minutes.

During this time, a person risks getting the following complications:

1. Partial damage to motor abilities;
2. Possibility of complete paralysis;
3. The patient falls into a coma;
4. If the case is severe, then the person dies.

Pathology is divided into ischemic and hemorrhagic types.

The cerebellum performs important functions in the body. Despite its small size, only 10% of the volume of the entire brain of the head, it ensures clear coordination of all human processes, controls the musculoskeletal system, and helps maintain muscle tone. Cerebellar stroke is dangerous because all of the above functions are disrupted.

Ischemic stroke: what is it?

An ischemic stroke occurs when there is an obstruction in the blood vessels supplying blood to the brain.
The main condition for this type of obstruction is the development of fatty deposits lining the walls of the vessel. This is called atherosclerosis. The definition of the nosological form of the disease is based on three independent pathologies that characterize local circulatory disorders, designated by the terms “Ischemia”, “Infarction”, “Stroke”:

• ischemia is a deficiency of blood supply in a local area of ​​an organ or tissue.
• A stroke is a disruption of blood flow in the brain due to rupture/ischemia of one of the vessels, accompanied by the death of brain tissue.

With ischemic stroke, symptoms depend on the type of disease:

1. Atherothrombotic attack - occurs due to atherosclerosis of a large or medium-sized artery, develops gradually, most often occurs during sleep;
2. Lacunar - diabetes mellitus or hypertension can cause circulatory problems in small-diameter arteries.
3. Cardioembolic form - develops as a result of partial or complete blockage of the middle artery of the brain by an embolus, occurs suddenly during wakefulness, subsequently embolisms may occur in other organs;
4. Ischemic, associated with rare causes - dissection of the arterial wall, excessive blood clotting, vascular pathologies (non-atherosclerotic), hematological diseases.
5. Of unknown origin – characterized by the impossibility of determining the exact causes of occurrence or the presence of several causes;

From all of the above, we can conclude that the answer to the question “what is an ischemic stroke” is simple - a violation of blood circulation in one of the areas of the brain due to its blockage with a blood clot or cholesterol plaque.

There are five main periods of completed ischemic stroke:

1. The most acute period is the first three days;
2. Acute period – up to 28 days;
3. Early recovery period – up to six months;
4. Late recovery period – up to two years;
5. The period of residual effects is after two years.

Most ischemic cerebral strokes begin suddenly, progress quickly, and result in death of brain tissue within minutes to hours.

Based on the area of ​​damage, cerebral infarction is divided into:

1. Ischemic stroke on the right side – the consequences mainly affect motor functions, which are subsequently poorly restored, psycho-emotional indicators may be close to normal;
2. Ischemic stroke on the left side - the consequences are mainly the psycho-emotional sphere and speech, motor functions are restored almost completely;
3. Cerebellar – coordination of movements is impaired;
4. Extensive - occurs when there is a complete absence of blood circulation in a large area of ​​the brain, causes swelling, and most often leads to complete paralysis with the inability to recover.

Pathology most often occurs in people of old age, but can happen at any other age. The prognosis for life is individual in each case.

Etiology

Typically, the development of cerebellar stroke is influenced by various pathological conditions in the body and its physiological changes:

1. advanced age;
2. presence of diabetes;
3. hypertension;
4. pathologies of blood vessels and heart;
5. high platelet count in the bloodstream;
6. vasculitis;
7. violation of the permeability of vascular walls;
8. an increase in plasma elements such as glucose and cholesterol;
9. presence of extra pounds;
10. passion for alcoholic beverages and smoking;
11. previous traumatic brain injuries.

Reference! Any of the above reasons should prompt a person to periodically visit the clinic and undergo a full examination.

Useful video on the topic:

Ischemic stroke

This condition is diagnosed more often than others.
With an ischemic type of stroke, blockage of one or several vessels is observed.

Moreover, complete closure does not always occur; it can also be partial.

Due to this condition, blood flow to the cerebellum slows down, and necrosis of these areas occurs. In medical terminology, ischemic stroke is also called cerebellar infarction.

Hemorrhagic stroke

Such a stroke in the cerebellum is extremely rare. Here it is not the blood flow that is disturbed, but the condition of the vessel in a certain area. Most often there is a rupture. Since the cerebellum is small in size, even minor damage to the vessel is enough for a hemorrhagic stroke to be diagnosed. The condition can develop against the background of a head injury or vascular aneurysm.

Kinds

The extent of damage to the cerebellar tissue affects the symptoms of the pathology, the severity of the course, and treatment tactics. The isolated type, which occurs when a single vessel is affected, is easier and has fewer negative consequences than the extensive one.

Isolated cerebellar stroke

With minor pathological foci, the disease can pass unnoticed by the patient in the form of transient attacks. At the same time, they act as harbingers of a major stroke.

With an isolated lesion, dizziness, unsteadiness of gait, and pain in the back of the head occur. Characteristic hearing dysfunctions.

Extensive cerebellar stroke

The pathology is characterized by high mortality. Damage to the left or right hemisphere is characterized by severe cerebral symptoms:

• headache;
• disorientation;
• incoordination;
• breathing and swallowing disorders;
• cardiac disorders.

With extensive lesions, loss of consciousness and coma lasting up to 7 days are possible.

When a third of the hemispheres or more are damaged, hydrocephalus occurs, compression of the brain stem, which causes the death of a person.

And also read on our website: Types of stroke and their differences

Symptomatic manifestations

The symptoms and first signs of a cerebellar stroke are generally the same as with other types of strokes. They appear as follows:

1. Intense pain in the back of the head;
2. Tremor of the fingers and toes, possible trembling of the lower and upper extremities or even the body itself;
3. You feel nausea like that that occurs when you get motion sickness in a car;
4. Uncontrollable tremor of the eyeball occurs, followed by loss of consciousness;
5. The mouth feels dry, which even causes difficulty swallowing;
6. Motor skills and coordination of movements suffer;
7. Speech function disorder;
8. Lack of balance;
9. Respiratory dysfunction, heart failure.

Reference! When a person cannot make simple movements during a stroke, this condition is called asynergia.

Diagnostics

The clinical picture of what is happening is very clear and the doctor, without diagnostic measures, can guess what triggered the person’s condition.
But to be completely sure, additional research will be needed.

The examination will help make an accurate diagnosis and identify the post-stroke condition in the early stages, which will allow you to choose the most effective treatment. The basis of diagnostic measures are:

1. Ultrasound - this method determines the presence of cerebellar displacement and allows you to find the damaged artery;
2. CT scan – reveals the localization of hemorrhage, assesses its extent and predicts the depth of the affected tissues;
3. A general blood test and its biochemical indicators - these diagnostic methods make it possible to identify the cause of the development of a stroke and will help prevent repeated attacks, possible complications and pathological conditions that have developed in connection with this.

Basic principles of treatment

Treatment is mostly etiotropic in nature, that is, it initially affects the cause of the stroke in the cerebellum. This therapy is called systemic thrombolysis. Thrombolytic treatment is primarily aimed at restoring blood circulation in the vessels.

Despite its effectiveness, this method is not always used, as it has a number of contraindications.

It is indicated immediately after a stroke has occurred and only if it is ischemic.

If you have time to give the patient the appropriate medications, the consequences of the attack can be prevented or minimized.

The most commonly used means:

1. Antiplatelet agents - these include Aspirin or Curantil. They are able to reduce blood density, which means they are preventive agents for blood clots;
2. Anticoagulants - in the form of heparin and its low molecular weight fractions. Prevents the development of thrombosis, especially if the patient is immobilized;
3. Antihypertensive medications can reduce pressure in the arteries when it increases;
4. Statins are medications aimed at reducing cholesterol levels in the blood. These include Atorvastatin, Simvastatin, Rosuvastatin, etc.;
5. Neurometabolic drugs such as Glycine, Mexidol, Ceraxmon additionally nourish brain tissue. They are used for a long time.

Surgical intervention is often indicated for hemorrhagic cerebellar stroke or ischemic attack with signs of dislocation.

The two most commonly used surgical methods are:

1. Ventriculostomy , in which a shunt is installed;
2. Trepanation , characterized by decompression therapy.

Causes and risk factors

Hemorrhagic or ischemic stroke of the cerebellum is a consequence of problems existing in the body. The following risk factors can lead to the development of this pathology:

• Hypertension.
• High sugar.
• High cholesterol.
• Atherosclerosis.
• Heart diseases.
• Metabolic disorders.
• Previous heart attacks and strokes.
• Coagulation disorder.
• Bad habits.
• Obesity.
• Sedentary lifestyle.
• Stress.
• Poor nutrition.
• Taking hormonal drugs.

A special risk group includes men over 60 years of age with the problems described above. In order to significantly reduce the risk of stroke, you need to carefully monitor your health. If you feel unwell, you should consult a doctor. It is worth noting that the most common cause of death in ischemic cerebellar stroke is late diagnosis. The patient may only experience dizziness or headaches and not see a doctor.

Recovery

Recovery from this type is quite possible, but you need to follow a number of recommendations.
Post-stroke recovery involves not only drug therapy; daily and nutritional regimen is also important.

At first, all nutrients will be supplied through the tube.

It will protect the patient from getting food particles into the respiratory system. Otherwise, a complication will begin, when pieces of food penetrate the respiratory tract, the patient will begin to choke, and this can provoke a repeat attack of stroke.

Specific therapy to lower blood pressure is important, which is achieved by administering thrombolytics and anticoagulants. In some cases, the blood clot will have to be removed surgically. During the recovery period, it is important to take neuroprotectors, including Euphyllin, Glycine or Cavinton.

Rehabilitation begins after the patient's condition has stabilized. At this time, massage, breathing and restorative physical exercises, and physiotherapeutic procedures are added to the main treatment. For many patients, psychological professional help is needed; the support of family and loved ones comes first.

Forecasts

The prognosis and life expectancy after a cerebellar stroke will mainly depend on the following indicators:

1. What is the extent of development of the stroke focus;
2. Primary development of pathology;
3. Age indicator of the patient;
4. The presence or absence of concomitant pathologies;
5. Timely medical assistance.

If the prognosis for recovery is favorable, the person’s disability is excluded. But still, the patient may be periodically disturbed by such manifestations of the body as unsteadiness during movement, dizziness, and nausea.

In any case, the prognosis for recovery will depend entirely on the cause of the stroke; if it is not eliminated, then in the near future there is a risk of relapse of the disease.

In the first month, up to 25% of patients die, mainly due to cerebral edema, in other cases - due to pneumonia, blockage of the pulmonary artery and other pathologies.

The first 3 days account for 40% of deaths. 60-70% remain with neurological disorders after suffering a stroke. In 25-30% they will never be cured. Relapse occurs in 30% of patients.

Symptoms of cerebellar ischemia

Manifestations depend on the exact localization, involvement of neighboring structures, and the extent of destruction of nerve tissue.

General signs of an emergency are always present. They are caused by acute disruption of cerebral blood flow, increased intracranial pressure and general stress of the body.

Headache

It begins abruptly, the patient is able to name the exact moment. Unbearable, strong and painful in strength, does not subside even after taking specialized analgesic drugs.

The character is pressing, pulsating (follows the beat of the heart). Patients describe it as feeling like being hit with a hammer.

Localization - the back of the head, less often the parietal zone. A diffuse nature is possible, when the pain is diffuse and does not have a clear location.

Dizziness

It arises just as quickly. Since the cerebellum is affected, the patient is completely unable to navigate in space. It gets to the point where there is no way to tell where right, left, up and down are.

The world is mixed together, spinning. The ground is disappearing from under your feet. The patient is forced to take a lying position, only this helps to partially alleviate the painful symptom.

As the process progresses, the symptom subsides, although not always.

Nausea and vomiting

They have a reflex origin. Therefore, they do not bring relief after the act of emptying the stomach.

This is a typical symptom. If, in the case of poisoning, vomiting is the result of stimulation of a special center of the brain by toxic substances, in such a case there are no toxic components.

Irritation begins spontaneously, this is the result of ischemia. The brain gives chaotic signals to nerve endings.

The manifestation lasts a minimum of time, usually everything is limited to a couple of hours, then the symptom is independently reduced and does not appear again.

Weakness, drowsiness, asthenic phenomena

The patient feels very tired and is unable to perform even the simplest actions. Not only because of severe dysfunction of the nervous system. Severe fatigue also affects.

Depending on the type of central nervous system, the rate of excitation and inhibition, and the relationship between these processes, the development of one of the variants of a mental disorder is likely:

• A panic attack is accompanied by a pronounced feeling of fear; usually the patient himself cannot say what became the source of the emotional disturbance. The patient rushes about, cannot find a place for himself. Inadequate, therefore it can be dangerous.
• Another option is apathy. The person lies down and stops responding to outside stimuli. Attempts to attract attention are pointless, because reactions are sluggish or completely absent. A similar phenomenon may persist for several days after the emergency condition and all symptoms have subsided.

Cerebellar stroke is accompanied by focal manifestations:

• Nystagmus. Spontaneous left-right eye movements uncontrollable by the patient. The speed is high. The sign makes a frightening impression on others. It is provoked by the inability to suppress unnecessary movements.
• Discoordination. The patient is unable to walk smoothly and is unsteady. The reason is a disruption of the vestibular apparatus and, partly, muscle weakness. A person cannot control his own body normally. This is a variation of a neurological deficit. The patient will have to deal with it during the rehabilitation period.
• Tremor. Trembling in the limbs, chin. It is impossible to correct the condition by any voluntary effort.

A cerebellar stroke is accompanied by extrapyramidal symptoms reminiscent of those in advanced parkinsonism.

Extensive damage to cerebral structures gives the same manifestations, but they are much more severe.

With formal preservation of motor functions, the patient loses the ability to control the limbs and motor activity.