Saturday, November 30, 2013

Cerebellar stroke

Somebody gave my book a crappy review because there's nothing specifically about  cerebellar strokes. But there is. A stroke can happen in the cerebrum, cerebellum or brain stem. I don't have anything specifically about the cerebrum or brain stem strokes or cerebellar strokes. I just have stuff about stroke. 


Is there something inherently different about cerebellar stroke vis-a-vie strokes in the cerebrum or brain stem? No. What about a stroke that hits the posterolateral thalamus? Maybe the folks who have had a stroke that hit the posterolateral thalamus (or was exclusive to white matter or only hit the pituitary gland, or any of the other dozens of structures in the brain) should get their own chapters or books.  Actually, I'd love to see that happen. In the mean time, my book is a review of the neuroplastic process that encompasses all of those. Recovery from all of them fall under the same neuroplastic model of stroke recovery.

I don't like the template for recovery being contingent on where the stroke is. Again and again I stress that the view that the brain is NOT cordoned off into specific compartments that necessarily control specific functions. This notion, that the brain is sectioned off into independent exclusive sections is called the "mechanistic view of the brain". In fact, in my book there is a whole section (NEUROPLASTICITY AND HOW SCIENCE GOT IT WRONG) about this (brain=machine) mistaken perspective. 

Is there something inherently different about cerebellar stroke? No. 

What does the cerebellum do?

Cerebellum is Latin for "little brain." It sits at the bottom and back of the brain (3D animation here). The cerebellum is involved in providing precision and coordination movement. The cerebellum is said to "calibrate" movement. It doesn't initiate movement, it just makes movement smooth and coordinated. People who have had a cerebellar stroke often have an uncoordinated tremor. For example, if they were to reach out and try to touch target in front of them, and then their nose they would have difficulty targeting towards both. As the person got closer to the target end to their nose tremor in the targeting finger would increase. This phenomenon, called ataxia, is very similar to a phenomenon known as intention tremor. Find a possible neuroplastic option for the treatment of intention tremor here.

Notes about the cerebellum and cerebellar stroke.
  • Compared to the rest of the brain, damage to the cerebellum is a little "backwards." In most strokes, if the stroke affects the right side of the brain, the left side of the body is weak or paralyzed, and vice versa. With the cerebellum is the stroke is on the right side, the right side of the body is affected.
  • Cerebellar strokes are unusual. About 2% of all strokes are cerebellar.
  • It would be well and good to assume that the cerebellum is only involved in coordinating movement. However, like much of the brain, the cerebellum is poorly understood. It is now believed to have at least some role in higher level thinking as well as emotions
  • (Find an interesting piece on a cerebellar stroke survivor here.)
How do I rehab after cerebellar stroke?

It turns out that the same rules of plasticity available to the rest of the  brain are available to the cerebellum as well. Here's my suggestion: Forget about where the stroke was. Instead, focus your efforts on sequalae.

10 comments:

Linda said...

I am glad you posted on this topic. I did not realize how rare cerebellar strokes are but that explains why most of the professional people I was involved with really were not sure what to do with me regarding my balance issues. I embraced getting out there and doing exercises over and over to get arm and leg movement back and I counted on neuroplasticity to do the job. I must say it is a whole other thing to repeatedly do movements that make you feel dizzy or like you are falling- and the physiotherapists also get less motivated after you vomit on their nice shoes. I have had huge improvement in this regard but still working on it and I will ride a two wheeler yet!

Amy said...

Peter if the guy's name that gave you a bad review is Rudy Dankwort, ignore it. That guy frequently comments on my blog about how radically different cerebellar strokes are and it's annoying as all hell.

BrookeFuller said...

My husband has a cerebellar injury caused by his immune system attacking his brain. I can absolutely attest to the notion that cerebellar injuries may affect emotions and higher level thinking. He is absolutely fine (cognitively) in every other area besides reasoning, recall (thinking on the spot), inferring, planning, and his emotions have been quieted...they are not gone, but he is unable to connect emotionally like he used to. It has gotten better and continues to do so, praise God. But we were under the impression that his injury would only be physical. We were incredibly wrong.

Ashley Kloehn said...

My mom had an acute bilateral ceraballur stroke last Saturday. She is 50, has no risk factors, besides still being on birth control (which she no longer takes since stroke). She is still dealing with a lot of vertigo (can't turn her head to fast), headaches, and her heart races when she does too much walking (when we had to take her up stairs). They couldn't figure out why it happened, but next week we go to get a heart monitor to see if it could be a fib. She is dealing with a lot of changes of course and today I could tell she was understandably depressed. If anyone could email me to start a discussion, I have no previous knowledge on stroke and would appreciate any advice survivors have.

Lord Anthony Gusarin said...

my dad was diagnosed with right cerebellar stroke 8 days ago and was confined in ICU for close monitoring. he is conscious from the very start and his hands and feet are good but he is experiencing vertigo,headache and vomiting when trying to stand up or move..any ideas or suggestions that could help my dad to recover fast..help

Peter G Levine said...

Lord Anthony Gusarin, would you please email me at strongerafterstroke (at) yahoo.com?

Thanks!

Vick nick said...

Vick,
my mom was diagnosed with right cerebellar stroke 40 days ago and was confined in ICU for close monitoring. she is conscious from the very start and her hands and feet are good but she is experiencing vertigo,headache and vomiting when trying to stand up or move..any ideas or suggestions that could help my mom to recover fast..help

Vick nick said...

Same as Lord Anthony.....
my mom was also diagnosed with right cerebellar stroke 40 days ago and was confined in ICU for close monitoring. she is conscious from the very start and her hands and feet are good but she is experiencing vertigo,headache and vomiting when trying to stand up or move..any ideas or suggestions that could help my mom to recover fast..help

Peter G Levine said...

Vick nick, would you please email me at strongerafterstroke (at) yahoo.com?

Mitch Whorton said...

I had a cerebellar stroke over 4 years ago,and I have pretty bad nerve pain in both feet, my entire right leg, and the left side if my face and head. It's very annoying and unpleasant. I also still get dizzy when on my feet. Neuropathy medicines did nothing.

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