Clinical Outcome of Isolated Cerebellar Stroke—A Prospective Observational Study

If this is so much better than NIHSS scoring then write it up as a stroke protocol and get it distributed worldwide. Or are you lazy AND incompetent?

https://www.frontiersin.org/articles/10.3389/fneur.2018.00580/full?

Alina Nickel^1*, Bastian Cheng¹, Hans Pinnschmidt², Emine Arpa¹, Christos Ganos³, Christian Gerloff¹ and Götz Thomalla¹

• ¹Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
• ²Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
• ³Department of Neurology, Charité, University of Medicine Berlin, Berlin, Germany

Background: The aim of this prospective study was to investigate clinical deficits of patients with isolated cerebellar stroke applying a dedicated clinical score, the modified International Cooperative Ataxia Rating Scale (MICARS) and identifying factors that influence recovery.

Methods: Fifteen patients with acute isolated cerebellar stroke received a standard stroke MRI on the day of admission and were clinically assessed using the mRS, NIHSS and the modified International Cooperative Ataxia Rating Scale (MICARS) on day 1, 3, 7, 30, and 90. A generalized linear model for repeated measures was employed to analyze the effect of stroke lesion location, volume, days after stroke, patient age, and MICARS score at admission on the total MICARS score.

Results: Median patient age was 54 years, lesion location in most cases was right (87%) and in the PICA territory (11/15). Median lesion volume was 3.2 ml. Median NIHSS was 1. The median MICARS decreased from on day 1 with 23–4 at day 90. The generalized linear model identified MICARS score at day 1, lesion location, days after admission and the interaction of the last two on the total MICARS score, whereas there was no significant effect of stroke volume or patient age.

Conclusions: Isolated cerebellar stroke can present with low NIHSS while more specific scales like the MICARS indicate a severe deficit. Patient age at onset of stroke and lesion volume had no significant effect on recovery from cerebellar symptoms as opposed to severity of symptoms at admission and lesion location.

Introduction

Acute cerebellar stroke is a relatively rare subtype of acute stroke representing approximately 3% of all ischemic and hemorrhagic strokes (1, 2). Clinical symptoms of cerebellar stroke are manifold and can be subtle so that they are often not recognized at hospital admission (2). Symptoms are frequently underestimated or missed by standard clinical stroke scores such as the National Institutes of Health Stroke Scale (NIHSS). Dedicated clinical scales such as the MICARS are available (3) but not widely used in routine stroke diagnostic and treatment.

Imaging of cerebellar stroke also may be challenging. Whereas small ischemic lesions in the cerebellum are detectable by magnetic resonance diffusion weighed imaging (DWI), identification may be difficult or impossible on computed tomography (CT) (4). Missed diagnosis of cerebellar stroke is not only detrimental to the diagnostic work up of stroke etiology of individual patients but can also lead to serious complications (4).

Studies addressing the clinical course and functional outcome of patients with isolated cerebellar stroke are scarce, and little is known about factors that influence recovery from isolated cerebellar stroke. Therefore, we aimed to investigate the clinical course and prognostic factors of clinical deficits caused by isolated ischemic cerebellar stroke confirmed by Magnetic resonance imaging (MRI) in a prospective study applying a dedicated cerebellar symptom rating scale.