Visual rehabilitation following cerebellar stroke

Abstract

Aim: To present a small case series of patients with visual complications following primary acute cerebellar stroke, document the types of visual deficit that occur, examine recovery patterns and identify rehabilitation strategies available. Methods: A small, consecutive case series of patients referred to the Orthoptic Stroke Service at Sheffield Teaching Hospitals NHS Foundation Trust with primary acute cerebellar stroke in 2007–2008 is presented. The types of visual deficit that occurred and the orthoptist’s contribution to patient rehabilitation are outlined. Results: Seven patients were included in this series. All had manifest nystagmus with or without oscillopsia. The main complaint was of ‘blurred vision’. Nystagmus varied in different positions of gaze, down gaze being the most troublesome for rehabilitation. Other deficits identified were skew deviation, internuclear ophthalmoplegia, and fixation abnormalities including saccadic intrusions and square wave jerks. Recovery was often incomplete, although in most cases some functional improvement did occur and most often in primary position. Conclusions: Patients who have suffered cerebellar stroke, especially those with vague visual symptoms and those failing to respond to rehabilitation, should be referred for orthoptic assessment. This provides invaluable information that can explain difficulties with rehabilitation and give patients insight into their symptoms. Advice and therapy can help overcome problems in many cases.

Keywords

• Cerebellar stroke
• Diplopia
• Nystagmus
• Square wave jerks