These can be due to atherosclerosis or other vasculopathies, including arterial dissections, typically of the vertebral arteries in cerebellar strokes. The thrombotic phenomenon can occur in large or small vessels, and thromboembolic can travel from large to small vessels. These can be further subdivided by the source of the obstruction in the blood vessel, either through migration from the heart or directly at the vasculature. Ischemic strokes are caused by arterial obstructions that impair blood and oxygen delivery directly. 2018 9(1):580.Like all strokes, cerebellar infarcts are roughly divided into ischemic and hemorrhagic events. Clinical outcome of isolated cerebellar stroke – a prospective observational study. Nickel A, Cheng B, Pinnschmidt H, Arpa E, Ganos C et al. Acute obstructive hydrocephalus caused by cerebellar infarction: treatment alternatives. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. Bash S, Villablanca JP, Jahan R, Duckwiler G, Tillis M, Kidwell C, et al. Symptoms and signs of posterior circulation ischemia in the New England Medical Centre posterior circulation registry. Searls DE, Pazdera L, Korbel E, Vysata O, Caplan LR. Posterior circulation ischemia: then, now, and tomorrow. New England Medical Center posterior circulation registry.
Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, et al. In large volume cerebellar infarcts, neurosurgical treatment with occipital decompression or external ventricular drainage (EVD) can be lifesaving in patients who have acute hydrocephalus or raised intracranial pressure causing reduces consciousness 11. In PICA infarction, the outcomes are generally expected to be good 12. If the timing of diagnosis fits within 4.5 hours of the onset of symptoms, then patients can be treated with thrombolysis 9. Acute endovascular therapies, often in the form of lysis or clot removal, can be used, particularly in basilar artery occlusion 10. Treatment of posterior inferior cerebellar artery, and posterior circulation strokes in general, depends upon the nature, timing, and severity of symptoms. In the first twenty-four hours, studies show approximately 75-95% sensitivity for MRI diffusion-weighted images, compared to CT of 16% 8. MRI is far superior to CT in the sensitivity of acute ischemic stroke across all vascular territories. MR angiography and CT angiography both have very high sensitivity for vessel occlusion identification, at 87% and 100% respectively 7. CT angiography should be utilized if the patient fits thrombolysis therapy guidelines 6. As with all cases of suspected stroke, CT or MRI is required urgently to exclude hemorrhagic stroke.
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