[Diagnostic difficulties in cases of vasogenic lesions in the cerebellum]

The authors describe the clinical manifestations in 200 cases of cerebellar vascular lesions confirmed on autopsy. The clinical symptoms and signs included very little typical cerebellar signs, the most frequently observed changes were: gradually increasing coma, muscular hypotonia, sluggish reflexes, ocular signs. The diagnosis was made even more difficult by the presence of additional pyramidal signs. The causes of diagnostic errors emphasized by the authors are: 1) an erroneous conviction of doctors that vascular cerebellar lesions must be associated with cerebellar signs, 2) difficulty in carrying out whole neurological examination since gait and posture cannot be observed in these bedridden patients, 3) frequently cerebellar focal lesions are associated with focal lesions in other brain structures (brainstem and cerebral hemispheres) with consequent superimposition of various symptom complexes, 4) presence of profound coma which not infrequently blurs many signs. Nevertheless, the authors could have established the clinical diagnosis of vascular cerebellar lesions in one-third of these cases.