Management of Cerebellar Circuit Dysfunction
Clinical Manifestations and Recognition
- Cerebellar circuit dysfunction plays a role in neuropsychiatric conditions including obsessive-compulsive disorder through disruption of cortico-striato-thalamo-cortical circuits 3
Recognition of Deterioration in Cerebellar Dysfunction
- Clinical deterioration manifests as brainstem compression, depression in consciousness level, Glasgow Coma Scale score <12 on admission, or a decline of ≥2 points 5
- Monitor for decreased level of arousal or new brainstem signs, which indicate deterioration in cerebellar stroke 4
- Watch for radiographic deterioration appearing as fourth ventricular compression and evidence of hydrocephalus 5
Medical Management
- Transfer patients with significant cerebellar dysfunction to an intensive care or stroke unit for comprehensive treatment and close monitoring 2
- Osmotic therapy (mannitol or hypertonic saline) is reasonable for patients with clinical deterioration from cerebellar swelling 5
- Maintain normoglycemia (glucose <8 mmol/L) and treat hyperthermia 4
Surgical Management for Cerebellar Infarction
- In patients with cerebellar stroke who deteriorate neurologically, suboccipital craniectomy with dural expansion should be performed 1, 2
- If ventriculostomy is needed to relieve obstructive hydrocephalus, it should be accompanied by decompressive suboccipital craniectomy to avoid upward cerebellar displacement 1
Treatment of Medication-Induced Cerebellar Dysfunction
- For cerebellar syndrome induced by high-dose cytarabine or other chemotherapeutic agents, the causative drug should be discontinued immediately 6
- Recovery from medication-induced cerebellar dysfunction is variable, ranging from complete remission to persistent disabling ataxia 6
Management of Posterior Reversible Encephalopathy Syndrome (PRES) Affecting Cerebellum
- Stringent blood pressure control is crucial when PRES affects cerebellar regions 6
- PRES typically resolves within 2 weeks with appropriate supportive management 6