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.

Clinical Feature and Outcome in Spontaneous Cerebellar Hemorrhage: Determination of Treatment Strategies

BACKGROUND: Cerebellar hemorrhage may present with a wide spectrum of clinical manifestations, from a benign course with little to no neurological deficit to a rapidly fatal course with hydrocephalus and brainstem compression. However, controversy remains concerning the management of patients with cerebellar hemorrhage. The aim of this study was to set the criteria for conservative or surgical treatment and predictive factors of poor outcomes. METHODS: During the 5-year period from July 1997 through July 2002, a series of 64 consecutive patients with spontaneous cerebellar hemorrhage was evaluated. On admission, all patients underwent a standard neurological examination, and a computed tomography (CT) scan. The location and size of hematoma, hypertension, hydrocephalus, intraventricular hemorrhage and compression of quadrigeminal cistern on a CT scan were compared with the Glasgow coma scale (GCS) and Glasgow Outcome Scale (GOS). RESULTS: Patients with GCS scores of 13 or more at admission and with a hematoma of less than 15 mL showed good outcomes. Patients with GCS scores of 10 or less at admission or with a hematoma measuring 15 mL or more had poor outcomes. Patients with intraventricular hemorrhage (p<0.05), compression of quadrigeminal cistern (p<0.05), and hydrocephalus (p<0.05) in the brain CT had poor outcomes. CONCLUSIONS: In treating patients with spontaneous cerebellar hemorrhage, an initial GCS and CT scan were quite helpful in determining treatment strategies. For patients whose CT scan show intraventricular hemorrhages, compression of the quadrigeminal cistern, and hydrocephalus, intensive therapy should be deemed necessary.

Predictors of Outcome of Spontaneous Cerebellar Hemorrhage

It is generally agreed that a small hematoma can be treated conservatively, whereas a larger one requires aggressive surgery; the surgical indication for those that are medium-sized remains controversial. To determine the criteria for conservative or surgical management, the authors analyzed 64 cases of spontaneous cerebellar hemorrhage diagnosed by CT scan between January 1990 and May 1996. An assessment was made of the relationship of initial GCS(Glasgow Coma Scale) score and GOS(Glasgow Outcome Scale) to hypertension, the location and size of the hematoma, obstructive hydrocephalus, intraventricular hemorrhage and the CT appearance of the quadrigeminal cistern. The results may be summarized as follows: 1) The incidence of spontaneous cerebellar hemorrhage was 6.37%(64/1005 spontaneous intracerebral hemorrhage). 2) The location of hematoma and hypertension did not correlated with initial GCS and GOS(p>0.05, p>0.05). 3) Obstructive hydrocephalus, intraventricular hemorrhage and obliteration of the quadrigeminal cistern correlated with intial GCS and GOS(p<0.01, p<0.001). 4) In case of spontaneous cerebellar hemorrhage, the mortality rate was 17.2%(11/64). 5) Poor prognostic factors were initial GCS score of less than 10(p<0.05), hematoma volume greater than 15 ml (p<0.01), the occurrance of intraventricular hemorrhage(p<0.05), and obliteration of the quadrigeminal cistern(p<0.001).

Prognostic Factors in Spontaneous Cerebellar Hemorhage and Pontine Hemorrhage

The author studied 62 consecutive patients with spontaneous cerebellar hemorrhage and 38 patients with spontaneous pontine hemorrhage, diagnosed by computerized tomography scanning from May 1983 to December 1994 and assessed the relationship of outcome of initial GCS score, CT findings, and treatment modality. In cerebellar hemorrhage, good outcome was achieved in patients with high initial GCS score(>13), small hematoma, patent quadrigeminal cistern, absent hydroceohalic change, and the location of the hemorrhage in the hemisphere. Although the size of hematoma was an impotant prognostic factor, it had no constant bearing on the level of consciousness, degree of quadrigeminal cistern obliteration, and outcome. Absence of quadrigeminal cistern obliteration predicted a good outcome whether the hematoma was evacuated or not, as long as obstructive hydrocephalus, if present, was relieved darly. However, partial obliteration of the quadrigeminal cistern was a predictor of good outcome if the hematoma was evacuate d within 48 hours after the onset of hemorrhage. Total obliteration of the quadrigeminal cistern inevitably predicted an unfavorable outcome. In pontine hemorrhages, a good outcome was achieved in patients with high initial GCS score(>13), small size hematoma(10cc) inevitably showed an unfavorable outcome.