Our nurses should now be performing the BE-FAST screen (Balance, Eyes, Face, Arm, Speech, Time) at triage to identify possible acute stroke patients. If the screen is positive for acute onset of balance or eye findings, it is important for a physician to immediately assess the patient for a possible cerebellar stroke.
To adequately test the cerebellum, all four of the following must be assessed: limb ataxia, truncal ataxia, oculomotor control, and speech articulation
Correct patient selection (via determination of timing and triggers) is essential when performing the Dix-Hallpike maneuver or the Head Thrust Test
If vertigo is triggered by head motion and short-lived, perform Dix Hallpike → Epley Manuever
If vertigo is spontaneous and persistent, test visual fields, CN’s, cerebellum, and perform the HINTS exam to attempt to distinguish central from peripheral causes. These cases should be paged out as a Code Stroke if a peripheral vestibulopathy cannot be confidently diagnosed quickly.