cerebellar hemorrhage

Etiology

• hypertension (most common)
• amyloid angiopathy (common in elderly)
  • suspect in patient with hemorrhage outside distribution common for hypertensive hemorrhage
• arteriovenous malformations (AVM)
• bleeding diatheses
• pharmacologic anticoagulation
• cocaine may be precipitating factor

Pathology

• most commonly small penetrating vessels bleeding into the cerebellar parenchyma

Clinical manifestations

• vertigo, headache, neck stiffness 1st symptoms
• imbalance
• diplopia
• lethargy
• flaccid quadraplegia, decrebrate posture & coma if hemorrhage involves pons
• 1/3 of non-comatose patients deteriorate rapidly
  • 50% mortality
• hematomas > 50 mL are most likely to cause deterioration
• patients with amyloid-related hemorrhages
  • frequently normotensive
  • generally have prior cognitive deficits

Laboratory

urine toxicology for cocaine

Diagnostic procedures

• cerebral angiography
  • patients < 45 years of age
  • intraparenchymal hemorrhage related to cocaine (high incidence of vascular anomalies)

Radiology

• non-contrast computed tomography (CT) of the brain

Management

• see general measures under stroke (CVA)
• neurosurgery
  • posterior fossa decompression
    • evacuation of hematoma > 3 cm, especially if neurologic deterioration or evidence of brainstem compression
  • craniotomy for arteriovenous malformation (AVM)
• mannitol, barbiturate coma, hyperventilation to reduce intracranial pressure
• IV nitroprusside, nicardipine or labetolol to maintain systolic blood pressure between 140-160 mm Hg
  • assumption is that excessively high systolic blood pressure will increase hematoma size
• avoid statins
• neurorehabilitation

More general terms

• hemorrhagic stroke

Additional terms

• subarachnoid hemorrhage (SAH)