Outcomes in the Management of Spontaneous Cerebellar Hemorrhage

OBJECTIVE: The operative indications on cerebellar hemorrhage have been controversial especially when the patient condition is grave. Therefore we investigated whether it can be justifiable if we perform the surgery in poor clinical grade. METHODS: Clinical records and computerized tomography(CT) films of the 89 patients, who were undergone hospital treatment due to spontaneous cerebellar hemorrhage between May 1997 and May 2004, were retrospectively researched. RESULTS: The study population consisted of 36 males and 53 female patients. The mean age was 65years (range 23~89). As a result of treatment, the patients, whose Glasgow coma scale(GCS) score were higher, showed better outcomes (p=0.001). 13 patients (14.6%) were below 5 in GCS score and 10 patients of these were operated. Among 10 patients, 4 patients (40%) showed good outcome and 5 patients (50%) had been dead. 3 patients (60%) of these dead patients had the findings of intraventricular hemorrhage, fourth ventricular obliteration and hydrocephalus in CT scan. CONCLUSION: This study suggests that operation may be justifiable in clinically poor grade patient with spontaneous intra cerebellar hemorrhage.

Arteriovenous Malformation of the Scalp: Efficacy of Computed Tomography Angiography

We report a rare case of scalp arteriovenous malformation(AVM). A 55-year-old woman presented with a pulsatile palpable mass on her left temporo-parietal scalp. She complained of insomnia because of bruit, which was audible when she lay on her left side. Computed tomography angiography(CTA) for the scalp vessel showed AVM on the left temporo-parietal region. Multiple enlarged arteries, such as the superficial temporal artery, posterior auricular artery, and occipital artery, were directly connected to the elongated dilated superficial temporal vein. Digital subtraction angiography also showed similar results. Fistulous portions were clearly delineated on both modalities. Surgical excision of the malformations, including feeding arteries and the draining vein, resulted in immediate relief of the symptoms. Usefulness of CTA in the diagnosis of vascular lesions on the scalp was emphasized.