Wide symptom variability of cerebellar infarction and comparison with pons infarction

Cerebellar infarction (CI) is a serious cerebrovascular disease that may present with non-focal neurological deficits, leading to delay of clinical recognition and treatment. The aim of this study is to investigate the variability of symptoms, diagnostic outcomes and early prognosis in patients with cerebellar infarction compared with pontine infarction (PI).

Between 2012 and 2014, a total of 79 patients (68 ± 14 years, female sex 42%, median NIHSS score: 5) with CI (43) and PI (36) were included and analyzed.

CI patients were admitted to emergency department one hour earlier compared with patients with PI. The most common symptoms in CI were dysarthria (67%), impaired coordination (61%), limb weakness (54%), dizziness/vertigo (49%), gait and stance uncertainty (42%), nausea or/and vomiting (42%), nystagmus (37%), dysphagia (30%) and headache (26%). Nineteen patients (44%) had symptomatic stenosis and two patients had vertebral artery dissection on duplex sonography and MR angiography.Four patients (9%) received a systemic intravenous thrombolysis with rt-PA and three patients received mechanical thrombectomy.Three months after the event, five patients (12%) had died and 15 (40) had disability with mRS (3-5).

Cerebellar infarction occurs with a high variability of symptoms and should be considered when non-focal symptoms are present.