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

Symptoms

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

Management

• 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)