The wobble is not vestibular — cerebellar hemorrhage
| Patient | 64F, acute phase |
|---|---|
| Lesioncerebellar territory, moderate | |
| Severity | NIHSS 8 |
| Days since onset | 4 |
| Before the strokeIndependent; pharmacist, swims twice weekly. | |
| Also on the chart | Hypertension |
| PrecautionsFall risk — guarded for all sitting work; Post-craniotomy wound left occiput | |
Test yourself
Where does today’s session start?
The teaching
The cerebellar case punishes pattern-matching: “dizzy” invites the vestibular toolkit, and the examination — no nystagmus, normal impulse, dysmetria on finger-to-nose — is what refuses it. The training is graded trunk control, the measure is ataxia-specific, and the pearl is the differential itself.
- New headache, vomiting or drowsiness — rebleed until proven otherwise
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the five-domain examination, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Milne SC et al. Cerebellar ataxia rehabilitation systematic review. J Physiother. 2017. Winstein CJ et al. Stroke. 2016 · Schmitz-Hübsch T et al. Scale for the Assessment and Rating of Ataxia (SARA). Neurology. 2006