Cerebellar Ischemia Symptoms And What You Need To Know

Cerebellar ischemia can present with a variety of symptoms depending on which blood vessel is affected. The cerebellum is supplied by three main arteries – the superior cerebellar artery (SCA), the anterior inferior cerebellar artery (AICA), and the posterior inferior cerebellar artery (PICA). Each of these arteries supplies different regions of the cerebellum, and damage or blockage in any of them can lead to distinct clinical manifestations.

Superior Cerebellar Artery (SCA) Involvement

When the superior cerebellar artery is affected, patients often experience ipsilateral cerebellar dysfunction along with contralateral deficits in pain and temperature sensation. This type of cerebellar ischemia typically occurs in individuals between the ages of 30 and 60, although atherosclerotic causes are more common in older adults. Early signs may include nausea, vomiting, vertigo, and headache. Additional symptoms can involve double vision, tinnitus, mild cognitive impairment, and impaired coordination.

Patients may also struggle with rapid alternating movements, experience tremors, exhibit reduced muscle tone, and develop dysdiadochokinesia. Speech may become slurred or explosive in nature, known as cerebellar dysarthria. Importantly, vibration sense and proprioception usually remain intact. Other signs include small-amplitude involuntary movements in the affected limb, possibly linked to damage to cerebellar nuclei. Central hearing loss and cranial nerve-related symptoms may also appear, including Horner's syndrome, characterized by ptosis, miosis, and anhidrosis on the affected side.

Anterior Inferior Cerebellar Artery (AICA) Involvement

Damage to the anterior inferior cerebellar artery typically presents with vertigo, cerebellar ataxia, tinnitus, and hearing loss. In addition, patients may develop peripheral facial nerve palsy, resulting in weakness on one side of the face. There may also be impairment in pain and temperature sensation on the same side of the face and on the opposite side of the body. These symptoms arise due to the involvement of both motor and sensory pathways affected by AICA ischemia.

Posterior Inferior Cerebellar Artery (PICA) Involvement

Ischemia involving the posterior inferior cerebellar artery commonly leads to vertigo, nausea, vomiting, and nystagmus. Patients may also experience difficulty swallowing, hoarseness, and dysphagia. Coordination problems such as difficulty holding a pen or writing may appear, along with crossed sensory deficits – meaning sensory loss on opposite sides of the face and body. Horner's syndrome may also be observed, further indicating brainstem involvement.