I’m currently in the midst of doing a literature review in preparation to write a case report. If you would like more background information on the case or information about the project, please click here. If you would like to see other article reviews related to this project, please click here.
Since I’ve been MIA from the blog taking a sign language class, I’ve got a back log of delicious research articles to share with you! Figured I’d do some very small synopses of some related articles. So here for your perusal….
This one wasn’t a full article; just the abstract on a poster presentation, but I thought the results were important. The N was small (5) so the generalizability is limited. BUT they found that PICA cerebellar strokes are particularly difficult to treat in the inpatient rehabilitation setting resulting in longer lengths of stay to achieve similar Functional Independence Measure (FIM) progression vs. other location subsets of strokes.
This study also had a small N (15). They used an outcome measure I hadn’t heard of, the modified International Cooperative Ataxia Rating Scale (MICARS) to identify factors that influence recovery from cerebellar stroke. They found that initial deficits and clinical recovery were well captured by the MICARS in this population. So I’ve added this outcome measure to my repertoire. They also found that isolated cerebellar stroke cases had “favorable” outcomes at 3 months post-stroke and that the lesion location was what influenced the degree of outcome the most. PICA territory strokes did better than SCA territory strokes.
Cerebellar strokes: a clinical outcome review of 79 cases as originally seen in Singapore Medical Journal
This one had a larger N of 79 and had some interesting stats result. In the intro they quoted some other researchers in stating that less than 10% of all stroke cases are cerebellar cases. But mortality rate is much higher in cerebellar strokes vs. other subtypes ranging from 23-38% of all cases. The purpose was to looks at the differences between outcomes in cerebellar hemorrhagic strokes vs. embolic strokes or infarcts and to identify risk factors for poor outcomes, like that high mortality. Overall, the hemorrhagic cases had poorer outcomes than the infarcts. “…[T]he following features on CT are strong predictors of poor outcome: (a)haematoma >3cm in diameter; (b) brainstem compression; (c) hydrocephalus; and (d) intraventricular extension from cerebellar haemorrhage.” They also mentioned a lesion volume over 20 cm “can serve as a red flag, enabling proper couselling of patients and their relatives, in anticipation of a likely poor outcome and mortality risk. It can also be used to remind attending physicians to schedule a prompt neurosurgical consult.” The researchers were unable to definitively state if surgical intervention to decompress hemorrhages was overall a good idea or not.
The researchers in this study took 14 cases ischemic cerebellar infarcts and compared their International Cooperative Ataxia Rating Scale (ICARS) (which is the larger version of the MICARS used in the previous study) at 7 days out and 90 days. Then they looked at the association between ICARS score and lesion location as determined by voxel-based lesion-symptom mapping methods. Which made an interesting map which is below.
The PICA territory was most predictive of outcomes. (Were there more PICA cases? The world will not know in this article.) But more interesting to me was that they found no correlation between functional outcome and age in this group. Age usually plays a large role in stroke recovery, so that makes me wonder.
This article was able to get a large N of 118 isolated dizzy folk, since dizziness is a common ER complaint. Of those stroke was found in 11.3% (cerebellum=21, pons=1, medulla oblongata=1, corona radiata=1). PICA territory was the highest number of culprits.