Summary
15 cases of intracerebellar haematomas [11 spontaneous, 2 traumatic and 2 unclear] were presented. Hypertension was thought to be a main risk factor in 91 % in 11 of the spontaneous cases. 11 cases were treated medically. They were usually conscious, scoring not less than 13 in GCS with subacute or chronic picture of illness and harbouring small haematomas below 3 cm in diameter situated almost always in the hemisphere and with no signs of ventricular dilation. Mortality in medically treated patients was 9% [1 case].
The remainder were discharged in good state, usually with no or only slight neurological deficit. Complete haematoma absorption took about 14 days. There were no signs of delayed hydrocephalus in subsequent CT scans.
When the haematoma was large, more than 3 cm in diameter, located usually in the vermis or in the vermis and cerebellar hemisphere, sometimes with ventricular involvement, the clinical presentation was acute and required CT diagnosis and surgical evacuation without delay due to low and deteriorating conscious level.
Postoperative mortality was 25%, but delayed mortality was 100%. Vertebral angiography was performed in all cases of spontaneous haemorrhage and was normal in 54%, revealed atheromatous changes in 36% and the signs of cerebellar haematoma in only 10%.
Arteriovenous malformations were excluded from this study. The authors believe, that the benign course of intracerebellar haematomas is more frequent than it was considered previously and needs no surgical treatment in many cases.
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References
Ballance HA (1906) Case of traumatic haemorrhage into the left lateral lobe of the cerebellum, treated by operation, with recovery. Surg Gynecol Obstet 3: 223–225
Bogousslavsky J, Regli F, Jeanrenaud X (1984) Benign outcome in unoperated large cerebellar haemorrhage. Report of 2 cases. Acta Neurochir (Wien) 73: 59–65
Brennan RW, Bergland RM (1977) Acute cerebellar haemorrhage. Analysis of clinical findings and outcome in 12 cases. Neurology 27: 527–532
Brillman J (1979) Acute hydrocephalus and death one month after non-surgical treatment for acute cerebellar haemorrhage. J Neurosurg 50: 374–376
Buczek M, Jagodziński Z, Kopytek M, Dabrowska E (1989) Zachowawcze leczenie pourazowych krwiakôw śródmôżdżkowych. Wiad Lek 42, 8: 550–555
Chin D, Carney P (1983) Acute cerebellar hemorrhage with brainstem compression in contrast with benign cerebellar hemorrhage. Surg Neurol 19: 406–409
Fisher CM, Picard EH, Polak A, Dalal P, Ojemann RG (1965) Acute hypertensive cerebellar hemorrhage: diagnosis and surgical treatment. J Nerv Ment Dis 140: 38–57
Freeman RE, Onofrio BM, Okazaki H, Dinapoli RP (1973) Spontaneous intracerebellar haemorrhage. Diagnosis and surgical treatment. Neurology 23: 84–90
Guillermain P, Lena G, Reynier Y, Vincentelli F, Jazzar A (1990) Hématomes intracérébelleux spontanés de l'adulte. 44 cas. Rev Neurol 146: 478–483
Hahn FJY, Kwan RIM (1976) Frontal ventricular dimensions on normal computed tomography. Am J Roentg 126: 593–596
Heiman TD, Satya-Murti S (1978) Benign cerebellar hemorrhages. Ann Neurol 3: 366–368
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484
Labauge R, Boukobza M, Zinszner J, Blard JM, Pages M, Salvaing P (1983) Hématomes spontanées du cervelet. Vingt-huit observations personnelles. Rev Neurol 139: 193–204
Little JR, Tubman DE, Ethier R (1978) Cerebellar hemorrhage in adults. Diagnosis by computerized tomography. J Neurosurg 48: 575–579
McKissock W, Richardson A, Walsh L (1960) Spontaneous cerebellar hemorrhage. A study of 34 consecutive cases treated surgically. Brain 83: 1–9
Ott KH, Kase CS, Ojemann RG, Mohr JP (1974) Cerebellar hemorrhage: diagnosis and treatment. A review of 56 cases. Arch Neurol 31: 160–167
Pozzati E, Grossi C, Padovani R (1982) Traumatic intracerebellar hematomas. J Neurosurg 56: 691–694
Rousseaux M, Lesoin F, Combelle G, Petit H, Jomin M (1984) Intérêt et limites de la dérivation ventriculaire isolée dans les hématomes cérébelleux non traumatiques. Neurochirurgie 30: 41–44
Salazar J, Vaquero J, Martinez P, Santos H, Martinez R, Bravo G (1986) Clinical and CT scan assessment of benign versus fatal spontaneous cerebellar haematomas. Acta Neurochir (Wien) 79: 80–86
Sedillot J (1813) Epanchément de sang dans le lobe droit du cervelet, suivi de la mort. J Gen Med Chir Pharm 47: 375–379
Seelig JM, Selhorst JB, Young HF, Lipper M (1981) Ventriculostomy for hydrocephalus in cerebellar haemorrhage. Neurology 31: 1537–1540
Shenkin HA, Zavala M (1982) Cerebellar strokes: mortality, surgical indications and results of ventricular drainage. Lancet 2: 429–432
Sokol JH, Rowed DW (1978) Traumatic intracerebellar haematoma. Surg Neurol 10: 340–341
Wright RL (1966) Traumatic hematomas of the posterior cranial fossa. J Neurosurg 25: 402–409
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Koziarski, A., Frankiewicz, E. Medical and surgical treatment of intracerebellar haematomas. Acta neurochir 110, 24–28 (1991). https://doi.org/10.1007/BF01402043
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DOI: https://doi.org/10.1007/BF01402043