Long-Term Outcome after Spontaneous Cerebellar Haemorrhage

Dolderer, Simone; Kallenberg, Kai; Aschoff, A.; Schwab, Stefan; Schwarz, Štefan

doi:10.1159/000080268

Cited by 44 publications

(82 citation statements)

References 69 publications

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“…Therefore this current study aimed to further establish a reproducible model of spontaneous cerebellar hemorrhage using stereotaxically injected collagenase (Lekic et al, 2008). This experimental paradigm could test therapeutic strategies for preventing the acutely devastating neurological deteriorations seen in patients (Jensen and St Louis, 2005; St Louis et al, 1998), and the application of cytoprotective interventions could further improve upon the lesion size and long-term neurological deficit of the survivors (Dolderer et al, 2004; Kelly et al, 2001; Okauchi et al, 2009; Strick et al, 2009; Thach, 1996). …”

Section: Discussionmentioning

confidence: 99%

“…Uncontrolled hematomal expansion causes abrupt ataxic neurological deterioration in nearly half of initially alert hospitalized patients (Rosenberg and Kaufman, 1976; St Louis et al, 1998) leading to a 40% mortality rate despite contemporary imaging and surgical methods (Flaherty et al, 2006; Hill and Silver, 2001). Almost 50% of these survivors will retain some cognitive deficits across motor-learning and visuospatial domains (Baillieux et al, 2008; Dolderer et al, 2004; Kelly et al, 2001; Strick et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

“…Therefore this study hypothesized that a rodent model of stereotaxic collagenase infusion could be used for translational purposes to extend the pathophysiological understanding of hematomal growth, brain edema, neurological deficit and brain atrophy after cerebellar hemorrhage (Baillieux et al, 2008; Dolderer et al, 2004; Kelly et al, 2001; Rosenberg and Kaufman, 1976; St Louis et al, 1998; Strick et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

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Characterization of the brain injury, neurobehavioral profiles, and histopathology in a rat model of cerebellar hemorrhage

Lekic

Rolland

Hartman

et al. 2011

Experimental Neurology

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Spontaneous cerebellar hemorrhage (SCH) represents approximately 10% of all intracerebral hemorrhage (ICH), and is an important clinical problem of which little is known. This study stereotaxically infused collagenase (type VII) into the deep cerebellar paramedian white matter, which corresponds to the most common clinical injury region. Measures of hemostasis (brain water, hemoglobin assay, Evans blue, collagen-IV, ZO-1, and MMP-2 and MMP-9) and neurodeficit were quantified twenty-four hours later (Experiment 1). Long-term functional outcomes were measured over thirty days using the ataxia scale (modified Luciani), open field, wire suspension, beam balance and inclined plane (Experiment 2). Neurocognitive ability was assessed on the third week using the rotarod (motor learning), T-maze (working memory) and water-maze (spatial learning and memory) (Experiment 3), followed by a histopathological analysis one week later (Experiment 4). Stereotaxic collagenase infusion caused dose-dependent elevations in brain edema, neurodeficit, hematoma volume and blood-brain barrier rupture, while physiological variables remained stable. Most functional outcomes normalized by third week, while neurocognitive testing showed deficits parallel to the cystic-cavitary lesion at thirty days. All animals survived until sacrifice, and obstructive hydrocephalus did not develop. These results suggest that the model can generate important translational information about this subtype of ICH, and could be used for future investigations of therapeutic mechanisms after cerebellar hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characterization of the brain injury, neurobehavioral profiles, and histopathology in a rat model of cerebellar hemorrhage

Lekic

Rolland

Hartman

et al. 2011

Experimental Neurology

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“…After providing conservative treatment again, she recovered well. The other case of recurrent CH was reported by Dolderer et al [6]. They analyzed 75 patients with spontaneous CH for a mean (SD) follow-up period of 49 (34) months and reported one case of recurrent CH.…”

Section: Discussionmentioning

confidence: 87%

“…Few reports have been published on recurrent CH because its prevalence is low and the initial mortality is high. To the best of our knowledge, only 2 cases of recurrent CH have been published without much detail and discussion [5,6]. We present a case of CH in a patient who did not take prescribed anti-hypertensive medications regularly and developed recurrence of the hemorrhage 4 months after the first episode of CH.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Cerebellar Hemorrhage: Case Report and Review of the Literature

Hsieh

Chu

et al. 2010

Cerebellum

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We report a case of cerebellar hemorrhage (CH) that recurred in other hemisphere after 4 months of the first attack. A 58-year-old man presented with general weakness and computerized tomography (CT) of the brain showed a 41 mm hematoma in the right cerebellum with intraventricular extension. The satisfactory outcome was obtained after emergency surgical intervention and intensive rehabilitation. However, the patient irregularly took the prescribed anti-hypertensive medication. Four months after first attack, the recurrent CH in left side showed by brain CT. Only 2 cases of recurrent CH have been published thus far. The patient is the third reported case of recurrent CH and the second case in which CH recurred in the other hemisphere. Further, no patient has been reported to develop recurrence of CH in such a short period after the first onset. We discuss the possible pathophysiology, clinical course, treatment outcome, risk factors associated with such events and the importance of blood pressure control for preventing recurrence.

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Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage

Kuramatsu

Biffi

Gerner

et al. 2019

JAMA

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114

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IMPORTANCEThe association of surgical hematoma evacuation with clinical outcomes in patients with cerebellar intracerebral hemorrhage (ICH) has not been established. OBJECTIVE To determine the association of surgical hematoma evacuation with clinical outcomes in cerebellar ICH.DESIGN, SETTING, AND PARTICIPANTS Individual participant data (IPD) meta-analysis of 4 observational ICH studies incorporating 6580 patients treated at 64 hospitals across the United States and Germany (2006-2015).EXPOSURE Surgical hematoma evacuation vs conservative treatment. MAIN OUTCOMES AND MEASURESThe primary outcome was functional disability evaluated by the modified Rankin Scale ([mRS] score range: 0, no functional deficit to 6, death) at 3 months; favorable (mRS, 0-3) vs unfavorable (mRS,(4)(5)(6). Secondary outcomes included survival at 3 months and at 12 months. Analyses included propensity score matching and covariate adjustment, and predicted probabilities were used to identify treatment-related cutoff values for cerebellar ICH. RESULTS Among 578 patients with cerebellar ICH, propensity score-matched groups included 152 patients with surgical hematoma evacuation vs 152 patients with conservative treatment (age, 68.9 vs 69.2 years; men, 55.9% vs 51.3%; prior anticoagulation, 60.5% vs 63.8%; and median ICH volume, 20.5 cm 3 vs 18.8 cm 3 ). After adjustment, surgical hematoma evacuation vs conservative treatment was not significantly associated with likelihood of better functional disability at 3 months (30.9% vs 35.5%; adjusted odds ratio [AOR], 0.94 [95% CI, 0.81 to 1.09], P = .43; adjusted risk difference [ARD], −3.7% [95% CI, −8.7% to 1.2%]) but was significantly associated with greater probability of survival at 3 months (78.3% vs 61.2%; AOR, 1.25 [95% CI, 1.07 to 1.45], P = .005; ARD, 18.5% [95% CI, 13.8% to 23.2%]) and at 12 months (71.7% vs 57.2%; AOR, 1.21 [95% CI, 1.03 to 1.42], P = .02; ARD, 17.0% [95% CI, 11.5% to 22.6%]). A volume range of 12 to 15 cm 3 was identified; below this level, surgical hematoma evacuation was associated with lower likelihood of favorable functional outcome (volume Յ12 cm 3 , 30.6% vs 62.3% [P = .003]; ARD, −34.7% [−38.8% to −30.6%]; P value for interaction, .01), and above, it was associated with greater likelihood of survival (volume Ն15 cm 3 , 74.5% vs 45.1% [P < .001]; ARD, 28.2% [95% CI, 24.6% to 31.8%]; P value for interaction, .02).CONCLUSIONS AND RELEVANCE Among patients with cerebellar ICH, surgical hematoma evacuation, compared with conservative treatment, was not associated with improved functional outcome. Given the null primary outcome, investigation is necessary to establish whether there are differing associations based on hematoma volume.

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Long-Term Outcome after Spontaneous Cerebellar Haemorrhage

Cited by 44 publications

References 69 publications

Characterization of the brain injury, neurobehavioral profiles, and histopathology in a rat model of cerebellar hemorrhage

Characterization of the brain injury, neurobehavioral profiles, and histopathology in a rat model of cerebellar hemorrhage

Recurrent Cerebellar Hemorrhage: Case Report and Review of the Literature

Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage

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