It’s sad to say this, but as an ER doc, often our first job is to filter out the BS. Patients show up in the ED with all sorts of nonsense complaints. “Difficulty typing” is never a BS complaint. Without even examining or talking to the patient, the diagnosis should be stroke. Less commonly, difficulty typing may have a different, non-acute dx.
I lied a little bit in the description. The patient had some subtle findings in his *right* cerebellar exam. Having said that, his finger-nose, heel-shin, patty-cakes (what i call the dysdiadokinesis test), and gait were all near-normal. You would not notice a deficit if you weren’t watching the patient carefully.
The patient had a cerebellar stroke (see image). Every cerebellar stroke that I have seen have shown up on the initial CT, contrary to what we’re often taught. Larger posterior strokes (e.g. basilar) that affect the cerebellum are often not seen on the CT, however. As you may notice, the lesion is on the left side, leading me to say to myself “I don’t know nothing, I thought the deficit was on the right.” However, on the subsequent mri-mra, the acute stroke was in the right cerebellum, which is not seen on this image (which disproves my earlier statement that I always see a cerebellar stroke on ct, so I don’t know anything after all).