[Cerebellar malacias in younger patients]

Based on four observations of cerebellar malacia in patients aged 40-45 years the authors describe the clinical picture of the disease, characterized by acute fierce occipital headache associated with nausea and vomiting. Focal cerebellar and stem symptoms develop frequently after a latency of several hours or days. None of the patients had signs of advanced arteriosclerosis or arterial hypertension:in two during the premorbid period arteriospastic manifestations were present--in one migraine, in the other angina pectoris. In three patients CT revealed bilateral malatic cerebellar affection, in one instance bilateral affection could be assumed from correlation of the clinical and CT finding. One patient died, necropsy revealed extensive malatic foci in both cerebellar hemispheres, while the finding on the entire vascular system was normal. Based on these observations and similar reports in the literature the authors discuss the possibility that arteriospasms are the decisive pathogenetic factor in the development of cerebellar malacia in young and middle age. The authors emphasize the importance of secondary oedematous changes for the prognosis and recommend for therapy a combination of common vasoactive substances with intensive antioedematous treatment and administration of calcium antagonists.