Skip to main content
×
×
Home

Misdiagnosis of Cerebellar Infarctions

  • Navdeep Sangha (a1), Karen C. Albright (a2) (a3) (a4), Hui Peng (a5), Farhaan Vahidy, Amelia Boehme (a2), Zhongxue Chen (a5) and Sean I. Savitz (a5)...
Abstract
Background

This retrospective study addresses for the first time the differences in clinical features and outcomes between those individuals with a cerebellar infarct who were correctly diagnosed on initial presentation compared to those who experienced delayed diagnosis.

Methods

A retrospective review was conducted of our stroke registry from 09/2003 to 02/2011. Forty seven patients had an isolated cerebellar infarction confirmed by MRI. Misdiagnosis was defined as the diagnosis given by the first physician.

Results

Among 47 patients identified, 59.6% had delayed diagnosis. Five patients in the correct diagnosis group received intravenous tissue plasminogen activator, compared to none in the delayed diagnosis group. Complaints of weakness were protective from delayed diagnosis (OR 0.087, 95% CI 0.019-0.393, p=0.001).

Conclusion

Patients with an isolated cerebellar infarction need to be considered when patients present with acute non-specific symptoms. Critical components of the neurological examination are omitted which are imperative to diagnose cerebellar infarcts. A thorough neurological examination may increase clinical suspicion of an ischemic stroke.

Contexte

Cette étude rétrospective aborde pour la première fois les différences entre les manifestations cliniques et l’issue clinique chez les individus atteints d’un infarctus cérébelleux lorsqu’un diagnostic exact a été posé au moment de la consultation initiale par rapport à ceux chez qui le diagnostic a été plus tardif.

Méthode

Nous avons effectué une revue rétrospective de notre registre de patients atteints d’un accident vasculaire cérébral entre septembre 2003 et février 2011. Quarante-sept patients avaient présenté un infarctus cérébelleux isolé, confirmé par IRM. Le diagnostic posé par le premier médecin qui a examiné le patient a été déterminé comme étant exact ou erroné.

Résultats

Le diagnostic a été tardif chez 59,6% des 47 patients identifiés. Cinq patients dans le groupe chez qui un diagnostic exact avait été posé initialement ont reçu de l’activateur du plasminogène tissulaire et aucun n’en a reçu dans le groupe de patients chez qui le diagnostic a été tardif. Le fait de se plaindre de faiblesse protégeait d’un diagnostic tardif (RC 0,087; IC à 95% 0,019 à 0,393; p=0,001).

Conclusion

Quand des patients consultent pour des symptômes aigus non spécifiques, un diagnostic d’infarctus cérébelleux isolé doit être envisagé. Des éléments essentiels de l’examen neurologique, qui sont indispensables au diagnostic de l’infarctus cérébelleux, sont omis. Un examen neurologique minutieux peut révéler un tableau clinique qui éveille des soupçons quant à la présence d’un accident vasculaire ischémique chez le patient.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Misdiagnosis of Cerebellar Infarctions
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Misdiagnosis of Cerebellar Infarctions
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Misdiagnosis of Cerebellar Infarctions
      Available formats
      ×
Copyright
Corresponding author
Correspondence to: Navdeep Sangha, Department of Neurology, Kaiser Permanente, Los Angeles Medical Center, 1505 N. Edgemont Street, Los Angeles, CA, USA 90027, Email: navdeep.x.sangha@kp.org.
References
Hide All
1. Bogousslavsky, J, Van Melle, G, Regli, F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19:1083-1092.
2. Kumral, E, Kisabay, A, Atac, C, et al. Spectrum of the posterior inferior cerebellar artery territory infarcts. Clinical-diffusion-weighted imaging correlates. Cerebrovasc Dis. 2005;20:370-380.
3. Kumral, E, Kisabay, A, Atac, C. Lesion patterns and etiology of ischemia in the anterior inferior cerebellar artery territory involvement: a clinical-diffusion weighted MRI study. Eur J Neurol. 2006;13:395-401.
4. American Heart Association. Heart Disease and Stroke Statistics, 2010 Update. Available from: http://circ.ahajournals.org/content/121/7/e46.extract
5. Edlow, JA, Newman-Toker, DE, Savitz, SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol. 2008 Oct7(10):951-964.
6. Chalela, JA, Kidwell, CS, Nentwich, LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293-298.
7. Simmons, Z, Biller, J, Adams, HP, et al. Cerebellar infarction: comparison of computed tomography and magnetic resonance imaging. Ann Neurol. 1986;19:291-293.
8. Savitz, SI, Caplan, LR, Edlow, JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007;14(1):63-68.
9. Bender, R, Lange, S. Adjusting for multiple testing--when and how? J Clin Epidemiol. 2001;54:343-349.
10. Stanton, VA, Hsieh, YH, Camargo, CA Jr, et al. Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians. Mayo Clin Proc. 2007;82:1319-1328.
11. Savitz, SI, Caplan, LR. Vertebrobasilar disease. N Engl J Med. 2005;352:2618-2626.
12. Kerber, KA, Brown, DL, Lisabeth, LD, Smith, MA, Morgenstern, LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37:2484-2487.
13. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581-1587.
14. Hacke, W, Kaste, M, Bluhmki, E, et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317-1329.
15. Kattah, JC, Talkad, AV, Wang, DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome stroke. 2009;40:1-8.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed