What's the diagnosis? By Dr. Eric Chavis

A 24 yo male presents with headahce and feeling unsteady.  Reports he has numbness in his right arm and is falling to the right.  He has right arm dysmetria and truncal ataxia; he leans to the right.  A stroke alert is called.  Eventually an MRI is completed and shown below.  What's the diagnosis?  Scroll down for answer






Answer:  Acute cerebellar stroke

Etiologies to consider

  • cardiac emboli, large vessel atherosclerosis, vertebral artery dissection, local arterial disease, hypercoagulable conditions, vasculitis, drug abuse
  • in this patient most likely culprit was cervical vertebral artery dissection


  • nonspecific - headaches, nausea / vomiting, dizziness, vertigo
  • truncal ataxia, dysmetria, nystagmus, dysarthria
  • cerebellar infarcts cause ipsilateral deficits


  • further work up for risk factors and treat underlying condition
  • aspirin
  • comatose patient with concern for brain herniation may require emergent surgical decompression (i.e. craniectomy)



Wright, J, et al. (2014). Diagnosis and Management of Acute Cerebellar Infarction. Stroke, 45(4), 56-58. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.114.004474