The clinical and computed tomographic features of cerebellar peduncular hemorrhage

Three patients with medial ventral cerebellar peduncular hemorrhages presented with a characteristic syndrome. This included (1) ipsilateral ataxia, (2) lower motor neuron type facial weakness, and (3) ipsilateral gaze paresis. The gaze paresis could not be overcome with a doll's head maneuver. The findings are explained by compression of the facial colliculus, with involvement of the sixth nerve nucleus and the middle cerebellar peduncle. Two patients were hypertensive; one was normotensive, and no etiology was identified with angiography. Of 40 patients with cerebellar hemorrhage seen at our institution, only those with medial cerebellar peduncular hematomas demonstrated this clinical triad, and we have not seen this clinical triad in other pathologic conditions. The diagnosis of a small medial cerebellar peduncular hemorrhage was established by CT. In two patients, repeat CT showed complete hematoma resolution. The patients shared a favorable prognosis.