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[Cerebellar hemorrhage. Clinico-topographic correlations and therapeutic indications]
Insights
Spontaneous cerebellar hemorrhages are diagnosed using CT scans. Early surgical intervention for larger, laterally located hemorrhages improves outcomes, while midline hemorrhages carry a high mortality risk.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Spontaneous cerebellar hemorrhages (SCH) are increasingly recognized with CT scanner use.
- SCH constitute 9% of all spontaneous intracranial hemorrhages.
Purpose of the Study:
- To categorize SCH based on size and location.
- To correlate clinical presentation and prognosis with hemorrhage characteristics.
- To evaluate the efficacy of surgical intervention.
Main Methods:
- Retrospective analysis of 28 cases of SCH.
- Classification into small (<3 cm) and large (>3 cm) hematomas.
- Further categorization of large hematomas based on location (midline vs. lateral).
- Correlation with clinical signs, CT findings, and treatment outcomes.
Main Results:
- Small hematomas (9 cases) are postero-medial, clinically subtle, with favorable outcomes.
- Large midline hematomas (7 cases) present with altered consciousness and neurovegetative signs, showing severe prognosis and high mortality.
- Large lateral hematomas (12 cases) present with cerebellar dysfunction, favorable outcomes with early surgery, but poor prognosis if delayed due to mass effect.
- CT scans consistently show 4th ventricle displacement and hydrocephalus in larger hemorrhages.
Conclusions:
- SCH can be categorized into distinct groups based on size and location, influencing clinical presentation and prognosis.
- Early surgical intervention is crucial for large lateral cerebellar hemorrhages.
- Midline cerebellar hemorrhages have a poor prognosis, even with surgery.
Abstract:
Spontaneous cerebellar hemorrhages are more easily recognized since the large use of CT scanner. In this series of 28 cases, they represent 9% of all spontaneous intra-cranial hemorrhages. Three main categories may be described. Small hematomas (less than 3 cm) are located in the postero-medial part of the cerebellum (9 cases): they are difficult to recognize, due to their limited clinical signs; their evolution is spontaneously favorable. Larger hematomas (more than 3 cm) represent two thirds of our clinical cases. When situated near the midline (7 cases) stupor or coma are quite constant, as neurovegetative signs; differentiating this type of case from brain-stem hemorrhages is difficult; prognosis is severe as even with surgery; there is a high mortality rate. When located more laterally (12 cases), their evolution is less acute: consciousness disturbances do not generally occur at the onset, whereas cerebellar disfunction is quite obvious; contrary to midline cases, these, when operated upon at an early stage, show a high success rate. If operation is delayed, the prognosis is much more serious due to the mass effect of this lesion in the posterior fossa. This is clearly demonstrated by CT scan which consistently shows displacement of the 4th ventricle with hydrocephalus of the lateral ventricles.