Ischemic cerebellar strokes are often associated with posterior inferior cerebellar artery (PICA) insufficiencies.
Unlike vertebrobasilar strokes which typically present with vertigo accompanied by evidence of of brainstem ischemia like diplopia, dysarthria, dysphagia, and numbness, cerebellar strokes may present with isolated vertigo, making the diagnosis elusive given the challenging task of differentiating a central from peripheral process.
Central vertigo, particularly when due to cerebellar infarct, tends to be associated with severe gait instability, such that the patient often falls while walking, nystagmus which may be multi-directional or purely vertical, and deafness or tinnitus tend to be absent.
Given that edema formation and mass effect are more likely to result from cerebellar infarcts as compared to other types of strokes, these patients are often best served in an intensive care setting for at least the first 24 hours following onset.
