a cerebellar stroke: what it feels like
9 minute read
the cerebellum is a small section of the brain, located to the back of the skull, where the nerves from the spinal cord connect with the brain. getty
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when george myette woke up one morning and had trouble finding his balance, he thought it may just be a case of vertigo.
when his balance continued to get worse, myette and his wife decided to take the ferry from their island home to the closest hospital. doctors were initially confused — something was clearly very wrong, but ct scans didn’t show any sign of a blockage in his brain, a typical sign of stroke. but then, they saw it: a small clot, located way at the back, towards the bottom of his brain in the cerebellum.
the cerebellum is a small section of the brain, located to the back of the skull, where the nerves from the spinal cord connect with the brain. although this section of the brain only makes up about 10 per cent of the brain’s mass, it contains more than 50 per cent of the neurons and plays a key role in motor functions like walking, balance, eye movements, speech and coordination.
cerebellar strokes are rare, accounting for only one to four per cent of all stroke events. because of the vague, confusing symptoms and the unique position of the cerebellum in the skull, it is also believed to have twice the mortality rate of other forms of stroke. symptoms of a cerebellar stroke can be remembered by the “three v’s:” vision, vomiting and vertigo. headaches, double vision and muscle tremors may also occur.
myette spoke to healthing about how he regained his balance and how bumping his head on a van door frame might have set off this chain of events.
this interview has been edited for length and clarity.
in the months leading up to your experience with a cerebellar stroke, did you notice any symptoms?
probably for maybe two or three months, maybe six months, there were a couple of incidents where i had a sudden vertigo. it was like i was standing there and suddenly it was almost like i was losing my balance, just getting disoriented. it happened a couple of times, i was a bit concerned about that, but i didn’t seek medical assistance because it just kind of disappeared. it was sort of momentary and i never thought of it as being something to do with any kind of a stroke. i thought it might have had something more to do with feeling fatigued, so i didn’t really worry about it too much.
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what happened when you had the stroke?
the evening of the actual stroke i had a headache. i don’t get headaches that often, but it was a fairly strong headache. it was on my left side, kind of down below the base of my skull. at that time, we were living out on the coast and we had a little bigger piece of property, so i was pretty active, doing a variety of things and manual stuff around our property. i assumed it was more of a stress, aggravation-type headache.
i woke up in the middle of the night and i went to get out of bed and i couldn’t stand up. this was probably three o’clock in the morning. i knew something wasn’t right but i didn’t know what, so i went back to bed.
i woke up at about quarter after seven in the morning and the symptoms were worse at that point. i was even less co-ordinated and really having to prop myself to even get anywhere in the room. i was also violently ill — i just had to throw up. i woke my wife up and i said, ‘i’m not sure what’s going on with me but i might be having a stroke or something because this is really weird, i just don’t know what’s happening.’
we lived on gabriola island, [b.c.,] which is near nanaimo. there’s an ambulance on the island but they have to take you over to vancouver island, which is three miles away on the ferry. i did take a couple of aspirin because i thought it would help in case it was a stroke. my wife was driving me to the ferry and i was so nauseous, i couldn’t even keep my head up.
we got to the ferry but, first, i had to get out throw up. and there was kind of a humorous side to that, though, because right across the street from the ferry there’s a pub. this was on a saturday morning and i thought to myself that somebody would be looking at me standing there throwing up, thinking that i had been in the pub too long the night before.
what happened when you got to the emergency room?
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by then, it was roughly nine o’clock. i went right in — they knew it was something fairly serious. they examined me quickly and then i had a ct scan. the doctor said he couldn’t see any brain damage, that it was probably a severe case of vertigo, because [my] vitals were pretty good. but when he checked my vision, he noticed something was off and had a neurologist look at the ct scan [and] sure enough, there was a clot. it was missed because it was very small and down in my cerebellum, which is the lower part of your brain.
they immediately started treatment for stroke, which is a blood thinner and an mri shortly after showed the actual brain damage that had occurred. it was somewhat superficial on the left side of my brain. that’s when they realized this was a cerebellar stroke. this wasn’t a “main brain” stroke.
i was admitted to hospital. i couldn’t walk, i had no control over my balance, but my reflexes were fine. i had strength in my legs and strength in my arms, just no balance.
i was in the hospital for five days. the nausea went away fairly soon, my reflexes were good, [but] still no balance. it took probably two days before i could actually use one of those hospital walkers.
how long did it take to be able to walk again?
i saw a physical therapist, and by the end of the third day, i was actually getting around not too badly. first, i was just in my room and then i was able to go down the hall. soon after i was climbing stairs with the therapist.
i wore a belt, almost like those weightlifter belts, but it had a handle on the back. so when you’re walking, the therapist holds on to the handle to steer you and keep you upright. by the fifth day, i was released from the hospital because i could walk without the walker. but i still had to be really careful because my balance was still affected.
soon i was walking every day, almost a kilometre — i took a walking stick just to make sure i could maintain balance. within two weeks, i was pretty much back to normal.
george myette emphasizes knowing the three v’s of identifying a cerebellar stroke: vision, vomiting, vertigo. supplied
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were there any other side effects from the stroke?
i really didn’t have any residual effects, except for numbness in my face. that was the one thing that took a while — it probably took six months for it to go away.
the interesting thing with a cerebellar stroke is it’s not like a ‘main brain stroke’ where if you have a stroke on the left side, it affects your right side and vice versa. with a cerebellar stroke, it affects the side where the stroke occurs. so since the clot was on my left side, it was my left side [that felt] numbness. as it improved, it was like when you go to the dentist and they freeze your mouth. as the freezing is fading, you start to feel more tingling — that’s kind of what it felt like.
was there a cause or trigger for the stroke?
the doctors never determined exactly what caused the stroke. they had me wearing a holter monitor to see if my heart was working properly, but they couldn’t find anything.
the only thing — and again this is just a possibility — that might have caused it, was that about six weeks before the stroke, as i got into our van, i misjudged where the top of the door was and banged my head on the top of the door opening. it didn’t really hurt, but it did jar my neck. it’s possible that this had broken a blood vessel in my upper spine, you know, just below my skull. and it’s possible that a blood clot may have migrated into my cerebellum.
are you on any treatments since the stroke?
i was put on low-dose aspirin and the specialist said i’ll be on it for the rest of my life because anyone who has had a tia or a stroke is much more likely than the average person to have another. i was [also] on a blood thinner for about three months.
have you had any other stroke-like symptoms since that night?
about a year later, one afternoon and — you know, when you’re retired you can have a nap in the afternoon — i was in my recliner, laid back, and i suddenly woke up and felt almost like a bolt of lightning go through my brain. it just felt like an electric shock. all of a sudden, i felt nauseous, i felt disoriented and i thought, i think i’m having another stroke. it wasn’t the same as when i had the stroke, but i was definitely a little wobbly.
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the er doctor said there [didn’t] seem to be anything going on. once you’ve had brain damage, your brain responds a little differently depending on what’s going on with the rest of you. he said likely what had happened was that during the nap, i probably shifted in the recliner which caused my brain to react to what was maybe a bit of vertigo and that’s what caused the electric shock sensation.
i did go back and have an mri and my brain was exactly the same as it was before. there was no additional damage or anything. i did have incidents of vertigo after that. i’m turning 69 this year and my gp said that there is a higher incidence of vertigo in seniors than in the general population.
you were super active before the stroke. has that changed?
i don’t know that i have the same level of energy, but then i’m aging too. i’ve also had other health issues in my life. i was a baby boomer type 1 hep c person which damaged my liver. that probably has some long term residual effects on a person, i’m guessing i’m just saying for me, in terms of energy levels, i don’t know that the stroke had really anything to do with my current energy level. i think that’s just my body.
this was an unbelievable story — not many people know about cerebellar strokes.
that’s why the three v’s are important for people to know [vision, vomiting, vertigo.] don’t just pass it off as vertigo. i think with vertigo, generally, balance and nausea is pretty common. but if you have severe nausea and you can’t walk and your vision is fluttering all over the place, then i would say it’s time to get to an emergency room.
emma jones is a multimedia editor with healthing. you can reach her at emjones@postmedia.com or on instagram and twitter @jonesyjourn.
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