I think one of the most successful health awareness campaigns ever is the American Stroke Association’s FAST acrostic for the signs and symptoms of stroke:
F = Face Drooping
A = Arm Weakness
S = Speech Difficulty
T = Time to Call 911
It’s hard to tell how many people have been helped by ordinary people recognizing that a loved one, co-worker, or friend is having an ischemic stroke (where blood supply to the brain is disrupted) and taking prompt action.
But not so fast. (Sorry for the pun). Did you know that there’s a particular type of stroke that doesn’t fit the FAST guideline?
Cerebellar strokes don’t follow the FAST rule
The cerebellum is the part of the brain at the back base of the skull. It plays an important role in motor function, or controlling movement, and maintaining balance. The cerebellum has two symmetrical sides, with each one controlling the same side of the body.
The blood vessels that supply the cerebellum include the interior inferior cerebellar artery, posterior inferior cerebellar artery, and superior cerebellar artery. If a blood clot lodges in any of these vessels, it can cut off blood supply to the cerebellum, causing a cerebellar stroke. Typically, a cerebellar stroke only impacts one side or part of the cerebellum.
Cerebellar strokes are less common than strokes that affect other parts of the brain. Stroke experts estimate that cerebellar strokes make up less than 10% of all strokes.
Some experts have recommended a different jingle for cerebellar strokes, the 3 Vs:
If these 3 Vs come on suddenly, it should raise suspicions for a cerebellar stroke. According to a Harvard neurologist’s published recommendations on dealing with patients who have sudden persistent dizziness, if the person can’t sit or walk without assistance, then physicians should treat it as a stroke.
If you see someone who needs help to sit and walk and has the 3 Vs, it’s time to call 911.
Other symptoms of a cerebellar stroke may include abnormal coordination or reflexes, problems swallowing, unusual and abnormal eye movement, and loss of consciousness.
When you get to the ER
I’ve recently handled some medical malpractice cases where people thought that individuals were having a stroke. They ran through the FAST test with them, though, and they passed. In these cases, they took them to the emergency room anyway, because the emergency physicians and nurses involved didn’t realize that the patients were having a stroke anyway.
One of the challenges facing healthcare providers when attempting to diagnose these symptoms is that they’re common to a lot of different conditions, other than cerebellar stroke.
When emergency personnel are trying to work up a patient for a potential stroke, they, too, may be thrown off when a patient passes the FAST test, but is actually having cerebellar stroke.
Therefore, I recommend that the patient or a loved one be absolutely clear in giving the history of what happened to the triage nurse and emergency physician. Emphasize all of the symptoms and that they came on suddenly. If the doctor is ready to discharge the patient and concludes that there wasn’t a stroke, I suggest being bold and politely asking about the possibility of a cerebellar stroke.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.