Cerebellar infarction

definition

A cerebellar infarction (cerebellum = cerebellum) is one Stroke in the cerebellumwhich is caused by the occlusion of the supplying arteries or bleeding from them. The vessels originate from the vertebral artery (Vertebral artery) and the basilar artery (Basilar artery). The branches of the vertebral and basilar arteries form the posterior circuit for supplying the brain, while the carotid arteries (Carotid artery) represent the anterior circulation. This supplies most of the parts of the cerebrum, the midbrain, the eye and other areas.

In addition to the cerebellum, the vertebral arteries also supply the brain stem, in which many vital body processes are controlled. The cerebellum can be called Movement and coordination center describe. In the case of disorders such as those that occur in a cerebellar infarction, there are various types of restrictions on movement.

causes

The cause of a cerebellar infarction is the occlusion of one or more supply vessels or a local cerebral hemorrhage. The cerebellum is supplied by three arteries:

• Inferior posterior cerebellar artery (the lower posterior cerebellar artery, PICA for short)
• Inferior anterior cerebellar artery (the lower anterior cerebellar artery, AICA for short)
• Superior cerebellar artery (the superior cerebellar artery, SCA for short)

While the PICA originates from the vertebral arteries, the AICA and SCA originate from the basilar artery. Symptoms are more severe when the larger vessels are blocked than when only one of the cerebellar arteries is affected.

In 80% of cases, the infarction is caused by an occlusion of the supplying vessels, which is known as an ischemic infarction (insufficient blood flow). This can be caused by arteriosclerosis (vascular narrowing due to calcification of the arteries), by thrombosis (blood clots that have loosened elsewhere and now lead to closure) or by other vascular diseases.
Bleeding in the brain is particularly favored by vascular damage caused by chronic high blood pressure, vascular malformations and the use of blood thinners (anticoagulants, anticoagulants). Important risk factors that increase the risk of stroke in general are high blood pressure, obesity, sedentary lifestyle, diabetes, long-term tobacco use and stress.
Read more about this under: Causes of a stroke

Closure of the PICA

PICA is the abbreviation for the lower posterior cerebellar artery with the Latin name Inferior posterior cerebellar artery. It arises from the basilar artery, which is created by the merging of the two vertebral arteries. The PICA supplies the lower (caudal) part of the cerebellum and gives off two smaller branches there for the blood supply.
If the blood supply is disturbed in this area, be it due to the occlusion of the artery or bleeding, the functions of the cerebellum are also impaired there. Since the conduction pathways of the nerves are very close together, it is not possible to clearly predict which exact symptoms will occur. Probable symptoms are, however, with a closure of the PICA Balance disorders and the resulting problems in coordinating movements on the affected side (Hemiataxia). It can also lead to hoarseness and language difficulties. Dysdiadochokinesis (see symptoms) occurs on the same side.

Symptoms

A cerebellar infarction can cause various symptoms that are characteristic of a malfunction in this area of ​​the brain. Thus, many cerebellar infarctions can be differentiated from strokes in the cerebrum.

Since the planning and coordination of movements are controlled by the cerebellum, a so-called cerebellar ataxia (lit .: disorder in the cerebellum). The patients walk unsteadily and seem almost drunk. This can go so far that even sitting upright becomes impossible due to the swaying.
The eyes and the sense of balance are closely linked in the brain. The cerebellum is also part of this network. In the event of a failure, the so-called Nystagmus, a gaze stabilization disorder. Affected people describe the symptom as restlessness or trembling of the eyes. The reason for this is the brain's attempt to adapt the eye movement to the misperceived body movement. In doing so, the body does not actually move - the brain is given a false state by the disturbance of the sense of balance.
Another symptom of a cerebellar infarction can be a Intention tremor be. Tremor describes the rhythmic movement of a part of the body. Intention means that the tremor is intensified, especially at the end of a movement. If a patient suffering from an intention tremor taps his nose with his eyes closed, the movement becomes more and more untargeted the closer he gets to the nose.
The so-called Dysdiadochokinesis is also the result of impaired movement coordination. Opposite movements can no longer be carried out smoothly. If you ask a person concerned e.g. pretending to screw in a lightbulb, the movement appears very choppy and becomes less and less with multiple repetitions.

In addition to these symptoms, you can also Language problems - choppy (chanted) Speech and disturbed articulation (Dysarthria), Muscle weakness (Hypotonia), but also excessive (Hypermetry) or movements that are too short (Hypometry) occur (collectively referred to as dysmetria / incorrect movement).
Due to the proximity of the cerebellum to the liquor system (Liquor = Nerve water) in the event of an extensive cerebellar infarction, the system (especially the 4th ventricle) can narrow or become blocked. It occurs through a ventricular relocation increased intracranial pressure and one Hydrocephalus (Nerve drainage disorder).

dizziness

Dizziness can be part of the clinical appearance of a cerebellar infarction. Since the cerebellum coordinates the movements, the eye creates a connection to the environment and the organ of equilibrium in the ear mediates the position of the body, these three systems are closely linked. Numerous nerve fibers form connections so that movements can be carried out in such a way that the person remains in balance. Only this complex system enables us, for example, to walk upright or to perform targeted movements at all.

In the case of a cerebellar infarction, these very pathways can be affected, which connect the cerebellum with the control center of the organVestibular nuclei) connects. One-sided damage can lead to excessive activation of the opposite equilibrium organ, such as when the equilibrium nerve (Vestibular nerve) would be damaged. There is no longer any stimulus or information from the damaged side. The body does not know which position the affected side is in and the balance system goes crazy - the patient becomes dizzy.

Read more about this under: Dizziness after a stroke.

diagnosis

The top priority in diagnostics is the physical and neurological examination in order to identify the heart attack itself. The neurological failures can be of various kinds, but in 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 the cause is occlusion or bleeding. For this purpose, a cCT (computer tomography of the head) is usually made. If there are bright (hyperdense) Areas, it is a matter of bleeding. If the cCT is initially normal, an occlusion can be assumed that should be treated immediately with lysis therapy (dissolution of the clot) if no more than 4.5 hours have passed since the symptoms first appeared.
Alternatively, an MRI of the brain (Magnetic resonance imaging) be made. This shows signs of a heart attack early on, such as the swelling around the infarct 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 irreversibly destroyed.

To find out the cause of the stroke - for example, where the clot came from - the heart and neck vessels are examined with ultrasound.

Read more on this topic at: This is how a stroke is diagnosed

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. Blood coagulation has to be checked, pain treated and blood pressure adjusted. It must exactly match the intracranial pressure mark (Nausea, impaired consciousness) are respected in order to be able to recognize and treat these early. For each individual case it must be decided whether an operative opening of the skull is necessary to relieve pressure.
Read more about this under: Therapy of a cerebral hemorrhage

If a vascular occlusion is the cause of the stroke, action must be taken quickly. Up to 4.5 hours after the symptoms first appeared, venous lysis therapy can be started to dissolve the stuck clot. A maximum of 6 hours may pass if the lysis is carried out via the arterial route or the clot is removed mechanically using a catheter. Lysis therapy at all may not be used in patients with impaired coagulation, bleeding or severe high blood pressure, after an operation, during pregnancy or bacterial inflammation of the heart valves.

In addition to acute therapy, basic care should also be guaranteed. A sufficient supply of oxygen, a stable circulation and monitoring of intracranial pressure are essential. If there is a slight high blood pressure, this should be maintained if a cerebral haemorrhage is excluded in order to improve the blood flow to the damaged brain tissue. Fever and blood sugar controls are also part of the necessary monitoring measures.

Read more on this topic at: Stroke therapy

Duration of a cerebellar infarction

The duration of a cerebellar infarction varies from case to case. It depends largely on the healing process. The stroke itself only lasts a few seconds - the symptoms can persist for anywhere from a few hours to several months. There is also the possibility that permanent damage will be sustained in severe infarcts with high cell death.
In order to keep the duration of the symptoms as short as possible, immediate care is essential. The earlier an existing occlusion can be treated, the higher the chances of a speedy recovery. After acute treatment, patients often begin a long healing process in which they often have to relearn basic skills such as walking or speaking. Practicing the coordination of movements is especially important in cerebellar infarction. Regular training of the restricted skills can greatly reduce the duration of the effects of the disease.

Read more on the subject at: What are the chances of recovery after a cerebral hemorrhage? and healing after a stroke
The stroke can lead to other serious consequences. Find out more at: These are the consequences of a stroke!

Left side cerebellar infarction

If the cerebellar infarction occurs on the left side, it mainly affects the affected half of the body, but these are usually not as severe as in an infarction of the cerebral cortex. Some of the nerve pathways that connect the cerebellum with other areas cross on the opposite side during their course. For example, the fibers, which are significantly involved in the control of voluntary motor skills - the consciously controlled movement. Since the motor nerves cross again on their way to the muscle, the disorders occur on the side of the infarct. The result is limited mobility in the left half of the body.

It is not only the fibers that are affected that lead out of the cerebellum, but also those that run into the cerebellum. Therefore sensation and coordination disorders occur on the same or left side.
The nerve fibers that carry the signals from the extremities and the rest of the body into the cerebellum for processing are actually intact. Unfortunately, the infarct focus means that information no longer reaches the system. The result is a lack of coordination with the symptoms already mentioned on the affected side.
If the language is conspicuous in the clinical picture, the location of the infarction cannot be precisely determined. Only the characteristic restriction of movement and the coordination disorder in combination with imaging procedures make an accurate diagnosis possible.

You might also be interested in: These are the consequences of a stroke!

Right side cerebellar infarction

In the case of a cerebellar infarction on the left side, the symptoms are exactly the opposite. The coordination difficulties and the restricted mobility are localized on the right side. The problem here for most people is that most mundane activities, such as Writing to be done. If the otherwise much used side of the body is suddenly restricted, this can mean enormous suffering for the patient. Exercises to resume all motor skills should be initiated immediately after the condition has improved so that the musculoskeletal system is challenged and relearned as quickly as possible.

Also read: These are the consequences of a stroke!