POCUS For Shoulder Dislocation

POCUS For Shoulder Dislocation

Introduction

Shoulder (glenohumeral) dislocation is a common clinical presentation in the emergency department, comprising about 50 percent of all major joint dislocations. The large range of motion of the shoulder with minimal inferior tendinous support makes it prone to dislocation. Plain film radiography has been the imaging modality of choice for most clinicians when evaluating the ED patient with a suspected shoulder dislocation. Recent literature has demonstrated the superiority of point-of-care ultrasound (POCUS) in detecting both anterior and posterior shoulder dislocations, making it another rapidly evolving tool to improve accuracy, decrease error, and improve efficiency.

Avoid XRAY In Back Pain

Avoid XRAY In Back Pain

Back pain is one of the most common emergency department presenting complaints, evaluating back pain , treating patients’ symptoms and to diagnose potentially life- or limb-threatening causes not always an easy task.

Usually in Emergency Department , we do require for radiological imaging despite the fact that imaging is not associated with improvement in clinical outcomes. 

Approach To PALPITATION

Approach To PALPITATION

Palpitation is a perceived abnormality of the heartbeat characterized by awareness of heart muscle contractions in the chest: hard beats, fast beats, irregular beats, and/or pauses. They are both a symptom reported by the patient and a medical diagnosis. 

Palpitations should be considered as potentially more serious if they are associated with dizziness, near-syncope, or syncope.

APO - Basic Understanding

APO - Basic Understanding

Pulmonary edema is the accumulation of extravascular fluid in the air sacs or air spaces (alveoli) and parenchyma of the lungs. Abnormal (pathologic) fluid accumulation causes the lungs to become stiff and the air sacs of the lungs to become waterlogged. As a result, breathing becomes very difficult. Acute pulmonary edema is one of the most common life-threatening medical emergencies; intervention is needed as soon as the diagnosis is suspected.

Disaster Management - BASIC

Disaster Management - BASIC

Disaster Management defined to be a continuous and integrated process of planning, organizing, coordinating and implanting measures which are necessary or expedient for :

• Prevention of danger or threat of any disaster, 
• Mitigation or reduction of risk of any disaster or its severity or consequences, capacity-building
• Preparedness to deal with any disaster, 
• Prompt response to any threatening disaster situation or disaster, 
• Assessing the severity or magnitude of effects of any disaster, 
• Evacuation, rescue and relief and rehabilitation and reconstruction,
  

Management Of TBI

Management Of TBI

Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death inchildren and young adults. The main objectives in managing TBI are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation.

In general, TBI is divided into two discrete periods: 

• primary and 
• secondary brain injury
  

Happy Deepavali

HAPPY DEEPAVALI

Traumagency Blog and Team wishing you a blessed Happy Deepavali

AIRWAY Assessment

AIRWAY Assessment

There are various definitions of “the difficult airway”, with no definition universally accepted : 

• In general terms, an airway is considered difficult when oxygenation and ventilation cannot be achieved in the desired manner
  
• ‘The difficult airway’ represents a complex interaction between patient factors, the clinical setting, and the skills and preferences of the practitioner

The 6D of Airway Management

The 6D of Airway Management

Assessment of the airway is recommended to predict the presence of a difficult airway before beginning airway management. The Mallampati classification system was implemented as a method to predict difficult intubation. However, its reliability as a predictor of difficult intubation has been questioned , and it assesses only one aspect of the airway for difficulty (i.e., intraoral disproportion). 

A comprehensive airway examination incorporates both quantitative and qualitative tests that together may increase the probability of predicting difficult intubation. One such system, the “6-D” method, introduced to examine the airway for six separate signs that can be associated with difficult intubation:

The Sarong CoverUp

The Sarong CoverUp

The Health Ministry has never issued any dress code for public hospitals and its facilities, said Deputy Health Minister Datuk Seri Dr Hilmi Yahaya.

He said there were no orders from the government or the Health Ministry on the issue and the public can wear anything as long as it is decent.

"The matter should not have arose, we have never issued any orders on how people should dress when going to government health facilities.

SARI For Tracheal Intubation

SARI For Tracheal Intubation 

The Simplified Airway Risk Index (SARI) is a multivariate model for airway assessment described by El-Ganzouri et al., enabling an estimation of the likelihood of a difficult direct laryngoscopy.

SARI studied under DIFFICAIR TRAIL in Denmark involving 28 Danish departments of anaesthesia and The Danish Anaesthesia Database (DAD) , a clinical database that contains selected quantifiable indicators, covering the anaesthetic process from the preoperative assessment through anaesthesia and surgery to the post-operative recovery period.

Seven parameters is used to calculate the SARI score: 

1. Mouth opening, 
2. Thyromental distance
3. Mallampati score
4. Movement of the neck
5. The ability to create an underbite
6. Body weight and 
7. Previously intubation history

Management Of NNJ 2015

Management Of NNJ 2015

Neonatal Jaundice (NNJ) or neonatal hyperbilirubinaemia is one of the most common medical conditions in newborn babies. All babies have a transient rise in serum bilirubin but only about 75% are visibly jaundiced. Jaundice is clinically detectable when the serum bilirubin levels are >85 μmol/L (5 mg/dl). 

Hyperbilirubinaemia is either unconjugated or conjugated. Without treatment, high levels of unconjugated bilirubin may lead to acute and chronic bilirubin encephalopathy. This may cause to neurodevelopmental problems including athetoid cerebral palsy, hearing loss and visual impairment.

OBSERVATION Ward

OBSERVATION Ward

Emergency department (ED) patients frequently require services beyond their initial ED care to determine the need for inpatient admission. Observation Ward ( OR ) , also known as Clinical Decision Unit ( CDU ) or Clinical Observation Unit ( COU ) are increasingly becoming an important component of the modern ED. 

Observation is by definition the use of appropriate monitoring, diagnostic testing, therapy, and assessment of patient symptoms, signs, laboratory tests, and response to therapy for the purpose of determining whether a patient will require further treatment as an inpatient or can be discharged form the hospital setting.

To promote quality of care and patient safety for ED observation patients, the American College of Emergency Physicians (ACEP) supports the following principles:

Snake Envenomation COURSE

Snake Envenomation Course

This course is sponsored by UKMMC, Dr Ahmad Khaldun. Intresting course for FREE!

Join Course

Cranial Nerve Examination

Cranial Nerve Examination

Cranial nerves are those nerves which arise from the brain and brain stem rather than the spinal cord. Nerves arising from the spinal cord are the peripheral nerves. There are 12 pairs of cranial nerves and these pairs of nerves passage through foramina in the skull, either individually or in groups. Cranial nerves are traditionally referred to by Roman numerals and these numerals begin cranially and run caudally.

Approach to AGGRESIVE Patients

Approach to AGGRESIVE Patients

Healthcare workers, especially staff in emergency departments, are likely to encounter aggression and violence every day. These problems can occur in combination. It is important that a diagnosis is made, to assess and manage these patients properly, with-out biases, and with the same thoroughness that you assess every patient with. Practice design and policies as well as staff training can help to reduce the risk of violence.

Aggression and violence may be a manifestation of underlying psychiatric disorders. These include drug psychosis, delusional states, mania and personality disorder. Some patients try to use aggression as means of achieving a particular goal, such as being seen earlier or obtaining drugs.

CPR 2015 Guidelines

CPR 2015 Guidelines

The European Resuscitation Council Guidelines for Resuscitation 2015 released today , provide specific instructions for how resuscitation should be practiced and take into account ease of teaching and learning, as well as the science. 

They were developed by Europeans and have been specifically written with European practice in mind.

CPR 2015 Guidelines                    Download
CPR 2015 Guidelines COSTR        Download 

CPR 2015 Posters                        Download

CPR 2015 Summary Of Changes   Download

Source : http://www.cprguidelines.eu

NUMB Chin Syndrome

NUMB Chin Syndrome

Introduction

Numb chin syndrome ( NCS ) also called mental neuropathy , is a rare sensory neuropathy of the mental nerve characterized by numbness, hypoesthesia, paraesthesia, and very rarely pain.

Because the inferior alveolar nerve has no motor fibers, NCS is a purely sensory neuropathy. Common symptoms include numbness over the lower lip, chin, and gingival mucosa; pain is not usually a feature of NCS. 

Dental causes, especially iatrogenic ones, maxillofacial trauma, or malignant neoplasm are etiologic factors for this rare syndrome. Compression of the mandibular division of the trigeminal nerve at the base of the skull by a tumor mass or leptomeningeal invasion may also cause NCS.

FLOOD , Are We Prepared?

FLOOD , Are We Prepared?

Malaysia is prone to annual flooding while experiencing a major flooding event at least once every five years where multiple states are affected. Towards the end of the year, northeast monsoons cause massive heavy downpours of rain, particularly in the eastern states. Such is the frequency of floods that traditional stilt houses are often constructed along coastlines and rivers.

10.1% of the country's total area with 5.67 millions people living in flood prone areas.

Due to its relative regularity, flood mitigation, forecasting and warning system efforts have been undertaken by various agencies to minimise impacts brought forth by floods. Such an event scrutinises Malaysia’s ability to respond to floods in the area of readiness, relief, and rebuilding.

HYPOGLYCAEMIA D10% Dilemma

HYPOGLYCAEMIA D10% Dilemma

Dextrose 50% (D50%) has its own long track record as the "Wonder Drug" of hypoglycaemia in Emergency Department but recent update on Dextrose 10% ( D10% ) usage for hypoglycaemia is quite intresting to discuss.

Drawbacks of D50

1. Rebound hypoglycemia

After administration of D50 there is an excess amount of glucose available, leading to increased uptake and utilization by the tissues, which suppresses both gluconeogenesis and glycogenolysis. Without continued administration of dextrose-containing fluids, this may result in rebound hypoglycemia. Moreover, with the loss of IV access, a busy ED, and a subsequent fingerstick in the 200’s, the decision to initiate such fluids may be overlooked or delayed, thereby facilitating this risk of rebound hypoglycemia.

Field TRIAGE

Field TRIAGE

TRIAGE , originated from French word trier which means “to sort” , to assign treatment priorities with limited resources. Attention must be given to the most salvageable with most urgent condition.

Slogan : 

Do The Greatest Good For The Greatest Number

To Do The Most For The Most


Field triage is important to understand due to increasing cases of disaster , limited personnel and resources. Triage practice  - divided into traditional and disaster

ORGANOPHOSPHATE Poisoning

ORGANOPHOSPHATE Poisoning

Introduction 

Organophosphates poisonings common in Malaysian hospitals , hold a very high level of mortality. Because of this, medical personnels must thoroughly understand the pathophysiology and signs and symptoms of organophosphate poisoning , and also its management. 

Organophosphates include insecticides (malathion, parathion, diazinon, fenthion, dichlorvos, chlorpyrifos, ethion), nerve gases (soman, sarin, tabun, VX), ophthalmic agents (echothiophate, isoflurophate), and antihelmintics (trichlorfon). 

Herbicides (tribufos [DEF], merphos) are tricresyl phosphate–containing industrial chemicals

INCONSOLABLE Crying Child

INCONSOLABLE Crying Child

Epidemiology 

Inconsolable crying children can be troublesome for parents and emergency department doctors , especially in the middle of the night.A comprehensive management is needed to determine the cause and provide the proper relief to the child.

Differential Diagnosis

1.Common Causes of an inconsolably Crying Infant

• Infantile colic
• Corneal Abrasion or eye foreign body
• Hair tourniquet (hair strangulating appendage)  eg at finger, toe, penis
• Teething
• Insect Bite

Approach NIH STROKE Scale

Approach  NIH STROKE Scale

The NIH Stroke Scale (NIHSS) ( The National Institutes of Health Stroke Scale) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. It composed of 11 items, each of which scores a specific ability between a 0 and 4.

 For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.

NIHSS total score is based on the summation of 4 factors. These factors are left and right motor function and left and right cortical function. The NIHSS assesses each of these specific functions by the stroke scale item listed in the chart below.

Approach To Neonatal CYANOSIS

Approach To Neonatal CYANOSIS

Cyanosis commonly divided into 2 :

• Central Cynosis
• Peripheral Cyanosis

Central cyanosis is a bluish discoloration of the skin, mucus membranes and tongue that is observed when deoxygenated hemoglobin is > 3g/dL in arterial blood or > 5g/dL (>3.1mmol/L) in capillary blood. It is associated with a low arterial partial pressure of oxygen (PaO2) and low hemoglobin oxygen saturation (SaO2) as measured by oxymetry. 

Another type of cyanosis, called peripheral cyanosis, involves a bluish discoloration of the skin but sparing of the mucus membranes & tongue. In this type, a normal PaO2 value is detected. In this case, increased oxygen extraction due to sluggish movement through the capillaries leads to increased deoxygenated blood on the venous side. Vasomotor instability, and vasoconstriction caused by cold, low cardiac output and polycythemia can all cause this slow movement through the capillaries.

Approach To Newborn FEVER

Approach To Newborn FEVER

Definitions

Fever is an extremely common pediatric presentation and has many different causes. Fever is not an illness but rather a sign. The physician’s job is to attempt to diagnose the cause of the fever and to determine if that cause requires treatment or not.

Fever is defined as a core body temperature greater than 38°C (100.4°F) in infants younger than 28 days and greater than 38.2°C in infants older than 1 month. Core body temperature is best estimated by rectal temperature.

Approach to RABIES

Approach to RABIES

Introduction

Rabies is a zoonotic disease (a disease that is transmitted from animals to humans), caused by the rabies virus, of theLyssavirus genus, within the family Rhabdoviridae. Domestic dogs are the most common reservoir of the virus, with more than 95% of human deaths caused by dog-mediated rabies.

Approach to HEADACHE

Approach to HEADACHE 

The gold standard for diagnosis and management of headache is a careful interview and clinical examination. 

Headache Red Flags—“SNOOP”

• Systemic Symptoms : (fever, weight loss) or 
• Secondary Risk Factors : (HIV, systemic cancer) 
• Neurological Symptoms or abnormal signs (confusion, impaired alertness or consciousness) 
• Onset : sudden, abrupt, or split-second 
• Older : new onset and progressive headache, especially in middle age >50 yr (giant cell arteritis) 
• Previous Headache History : first headache or different (change in attack frequency, severity, or clinical features) 

STEROIDS In Spinal Injury

STEROIDS In Spinal Injury

The Congress of Neurological Surgeons and the American Association of Neurological Surgeons released a revised version of the original 2002 evidence-based guidelines for management of acute cervical spine and spinal cord injuries

Of 112 recommendations (the previous version contained 76), 19 are classified as level I recommendations, 16 as level II, and 77 as level III.

Malaysian 3rd Edition Dengue CPG

Malaysian 3rd Edition Dengue CPG

Download : Dengue CPG 3rd Edition 

List of Recommendations : 

Recommendation 1

♥ The baseline HCT and WCC should be established as early as possible in all patients With suspected dengue infection.
♥ Serial FBC and HCT must be monitored as the disease progresses.

Child With MUSCLE Weakness

Child With MUSCLE Weakness

Introduction

Neurologists focus on identifying the location of the pathologic lesion as the first step in determining etiology. 

In the case of muscle weakness this would be :

• upper motor lesion - cerebral, posterior fossa, or spinal cord above the muscle groups affected spinal cord,
• lower motor lesion - anterior horn cells, motor nerves, neuromuscular junction - pre or post synaptic muscle fibers.

Cervical Spine IMMOBILISE

Cervical Spine IMMOBILISE

Patients with suspected or possible cervical spine injury must have their cervical spine properly immobilised until formal assessment occurs.

1.Any trauma patients with : 

• Unconscious
• Complaining of neck pain or tenderness or limitation of movement
• Using hands to support neck
• Has any neurological deficit
• Significant head /facial injuries

Hypertensive EMERGENCY

Hypertensive EMERGENCY

The situation is a true hypertension emergency when there is acute and life-threatening organ damage, such as hypertensive encephalopathy (headache, lethargy, seizures, coma), intra-cranial haemorrhage, aortic dissection, acute coronary syndromes (unstable angina/acute myocardial infarction), acute left ventricular failure with pulmonary oedema, or pre-eclampsia/eclampsia. The initial aim of treatment is to lower blood pressure in a rapid (within 2-6 hours), controlled but not overzealous way, to safe (not normal) levels – about 160mmHg systolic and 100mmHg diastolic, with the maximum initial fall in blood pressure not exceeding 25% of the presenting value. Too rapid a fall in pressure may precipitate cerebral or myocardial infarction, or acute renal failure.

Hypotensive agents should be administered intravenously when organ damage is potentially life-threatening. All patients should be admitted to a high dependency or intensive care bed, for continuous BP monitoring. The choice of drug will frequently depend on the underlying cause or the organ most compromised. In many instances, patients will be salt and water deplete and will require fluid replacement with normal saline in addition to antihypertensive agents. 

Spinal CORD Syndrome

Spinal CORD Syndrome

The spinal cord ends at the intervertebral disc between the first and second lumbar vertebrae as a tapered structure called the conus medullaris, consisting of sacral spinal cord segments. The upper border of the conus medullaris is often not well defined. The fibrous extension of the cord, the filum terminale, is a nonneural element that extends down to the coccyx.

The cauda equina (CE) is a bundle of intradural nerve roots at the end of the spinal cord, in the subarachnoid space distal to the conus medullaris. Cauda is Latin for tail, and equina is Latin for horse (ie, the "horse's tail"). The CE provides sensory innervation to the saddle area, motor innervation to the sphincters, and parasympathetic innervation to the bladder and lower bowel (ie, from the left splenic flexure to the rectum).

AF Amiodarone Or Digoxin

AF Amiodarone Or Digoxin

Atrial Fibrillation (AF) is by far the most commonly encountered in the Emergency Department and is associated with the potential for serious consequences including stroke, deterioration of underlying cardiac disease, prolonged hospital stay, and increased mortality. 

AF is an irregular, disorganized, electrical activity of the atria characterized by absent P waves and an irregular baseline on ECG.

ADRENAL Crisis

ADRENAL Crisis

Adrenal crisis and severe acute adrenocortical insufficiency are often elusive diagnoses that may result in severe morbidity and mortality when undiagnosed or ineffectively treated.

Although it is thought by experts that more than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are by far the most abundant and physiologically active. Regulation of the adrenal cortex is illustrated in the image below.

ADDISON Hyperpigmentation

ADDISON Hyperpigmentation

Addison disease is an autoimmune disorder in which the body attacks the adrenal glands, effectively shutting them down. Patients end up with a whole host of problems, including hypotension (from the lack of mineralocorticoids) and hypoglycemia (from the lack of cortisol). 

As the disease progresses, the adrenals put out less and less cortisol. The pituitary sees that drop in cortisol levels and responds by making more ACTH. ACTH is derived from a bigger precursor molecule called pro-opiomelanocortin (POMC). POMC is also a precursor for beta endorphin and melanocyte stimulating hormone (MSH) , so if you make more POMC (in order to make more ACTH), you’ll make more beta endorphin and MSH.

The beta endorphin doesn’t do much, as far as I know, but the MSH stimulates melanocytes, giving the skin a bronze color. Sometimes it’s an all-over bronze, like a tan (as in the photo above), and sometimes it’s more localized (in the gums, or in areas subjected to increased pressure, like over the knuckles or in skin folds).

However the bronze color manifests, it’s a telltale sign that the patient’s adrenal failure is primary (localized to the adrenal) and not secondary (due to hypopituitarism). In adrenal failure due to hypopituitarism, the whole problem is that the patient isn’t making ACTH (and thus the adrenals aren’t putting out their products) – so there’s no increase in MSH production and no hyperpigmentation.

START Triage

START Triage : Sorting of Patients

1. You can’t commit to “one-on-one” care 
2. You have to be fast – 30 sec or less per patient 
3. Very limited treatment is provided 

• Manually open airways 
• Clear airway with finger sweep 
• Control major bleeding Primary and Secondary Triage

Count Irregular Rhythm HEART Rate

Count Irregular Rhythm HEART Rate

How to count heart rate of irregular heart rhythm?

Count the number of R waves in a 6 second strip and multiply by 10.

For example, if there are 7 R waves in a 6 second strip, the heart rate is 70 (7x10=70).

Atropine Resistant BRADYCARDIA

Atropine Resistant BRADYCARDIA

Symptomatic sinus bradycardia is routinely treated in the emergency department with atropine and pacing. The current cases illustrate the importance of considering hyperkalamia, particularly in the presence of atropine-resistant symptomatic bradycardia. 

The administration of calcium in such cases acts to stabilise the myocardium and resolve the bradycardia. Blood gas analysis provides a rapid estimate of serum potassium concentrations, facilitating timely treatment. 

Pneumothorax

Pneumothorax

Pneumothorax is defined as the presence of air or gas in the pleural cavity (ie, the potential space between the visceral and parietal pleura of the lung), which can impair oxygenation and/or ventilation.

It is useful to divide pneumothoraces into three categories :

• primary spontaneous: no underlying lung disease 
• secondary spontaneous: underlying lung disease is present 
• iatrogenic/traumatic 

Clinical RISK Management

Clinical Risk Management

Definition :

- focus strategy
- aim:
1. Individual
2. Process
3. System

- to deliver safe error free patient care

Damage Control Resuscitation DCR

Damage Control Resuscitation DCR

Damage control resuscitation consist of 3 main component :

I.  Hemostatic resuscitation

II. Permeasive hypotension

III. Damage control surgery

SMOKE Inhalation Injury

SMOKE Inhalation Injury

Smoke inhalation injury is generally defined as the inhalation of thermal or chemical irritants , can be divided into : 

1. Types of injury : 

•            Thermal injury 
•            Chemical irritation 
•            Systemic toxicity

2. The location of the injury : 

• The upper airway 
• The tracheobronchial system or lower airway 
• The lung parenchyma 
• Systemic toxicity 

Personal Protective Equipment PPE

Personal Protective Equipment PPE

Personal protective equipment, or PPE, is designed to provide protection from serious injuries or illnesses resulting from contact with chemical, radiological, physical, electrical, mechanical, or other hazards. Careful selection and use of adequate PPE should protect individuals involved in chemical emergencies from hazards effecting the respiratory system, skin, eyes, face, hands, feet, head, body, and hearing.

No single combination of protective equipment and clothing is capable of protecting against all hazards. Thus PPE should be used in conjunction with other protective methods, including exposure control procedures and equipment.

Malaysian LAW Child Act 2001

Malaysian Child Act 2001

Malaysia enacted the Child Act 2001 [Act 611] to fulfill its obligation under the Convention on the Rights of the Child (CRC). Act 611 repealed the Juvenile Courts Act 1947 [Act 90], the Women and Girls Protection Act 1973 [Act 106] and the Child Protection Act 1991 [Act 468].

Act 611’s preamble provides that every child is entitled to protection and assistance in all circumstances without regard to distinction of any kind, such as race, colour, sex, language, religion, social origin or physical, mental or emotional disabilities or any status. The provisions of Act 611 are based on the four core principles of the CRC that is, non-discrimination, best interest of the child, the right to life, survival and development and respect for the views of the child.

BRAINSTEM Stroke Syndromes

BRAINSTEM Stroke Syndromes

Brainstem stroke syndromes refer to a group of syndromes that occur secondary to occlusion of small perforating arteries of the posterior circulation. The resulted infarction has characteristic clinical picture according to the involved area however, generally there is ipsilateral cranial nerve palsy and contralateral hemiplegia/hemiparesis and sensory loss.

INDUCTION Agents RSI

INDUCTION Agents RSI

Different clinical scenarios lend themselves to the use of certain induction agents when rapid sequence intubation (RSI) is needed.

Head injury or stroke — In the patient with potentially elevated intracranial pressure (ICP) from head injury or stroke or other conditions, adequate cerebral perfusion pressure must be maintained to prevent secondary brain injury. This means avoiding elevations in ICP and maintaining adequate mean arterial pressure. For these reasons, we suggest etomidate or ketamine be used for induction of these patients. 

The HEART Score

The HEART Score

Chest pain is a common presentation complaint to the emergency department (ED) and has a wide range of etiologies including urgent diagnoses (i.e. acute coronary syndrome (ACS), pulmonary embolism, aortic dissection) and non-urgent diagnoses (i.e. musculoskeletal pain, gastroesophageal reflux disease (GERD), pericarditis).

Some HINTS On Vertigo

Some HINTS on vertigo

Cerebellar infarction represents approximately 2.3 % of acute strokes overall.29 These can result from occlusion of the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), or the posterior inferior cerebellar artery (PICA). Larger cerebellar infarcts produce symptoms and signs localizing to the brainstem, such as diplopia, dysarthria, limb ataxia, dysphagia, and weakness or numbness. 

Approximately 10% of patients with cerebellar infarction can present with isolated vertigo, that is, vertigo with no localizing findings on motor, sensory, reflex, cranial nerve, or limb coordination examination. Most of these are infarcts of the medial branch of the PICA (96%).