An infarct of the cerebellum may be misdiagnosed in up to a third of patients. A number of factors may contribute to misdiagnosis or a delay in diagnosis.
Factors associated with misdiagnosis of a cerebellar infarct:
(1) young age (age < 60 years)
(2) non-specific symptoms (dizziness, vomiting, headache, unsteady gait)
(3) evaluation by a non-neurologist
(4) absent, incomplete or poorly documented neurologic exam
(5) normal CT at presentation without follow-up imaging studies
(6) failure to perform a diffusion-weighted MRI
(7) infarct in the distribution of the medial branch of the posterior inferior cerebellar artery (mPICA)
(8) vertebral artery dissection
(9) failure to recognize vascular risk factors (hyperlipidemia, atrial fibrillation, etc)
(10) absence of dysmetria and/or ataxia
Clues to the diagnosis may include (Guiang, Ellington):
(1) direction-changing nystagmus prominent to the side of the lesion or toward the side of falling
(2) disabling gait imbalance in the absence of vertigo.
