We hereby reported four healthy patients at baseline developed transient cardiac stunning after acute ischemic cerebellar stroke. Patients’ EKGs and cardiac enzymes were normal, and no cardiac intervention was pursued in the setting of presumed neurogenic cardiac outcome. Their cardiac dysfunction spontaneously returned to normal range after two to three months demonstrated on a repeated cardiac MRI or echocardiogram. Catecholamine surge seems to play a critical role in causing concurrent cardiac manifestation not only in the setting of acute cortical stroke involving insular cortex, but also can occur with acute cerebellar stroke in the absence of insular involvement.

Although acute stroke with insular cortex involvement is the common cause of cardiac stunning, other territory of acute stroke could also cause neurogenic cardiac dysfunction and should not be neglected, such as cerebellar infarct in this case series report.