Management of 50 spontaneous cerebellar haemorrhages

Mezzadri, Juan José; Otero, J; Ottino, C. A.

doi:10.1007/bf01446984

Cited by 51 publications

(56 citation statements)

References 27 publications

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“…The diagnosis must be made early, if not, most patients would die within 48 hours. 2 Uncontrolled hypertension is the commonest etiology of spontaneous cerebellar hemorrhage. 3,4 There are a few reports on vermal cerebellar bleed in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

Iyagba

Onwuchekwa

2016

Int J Res Med Sci

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Vermal cerebellar haemorrhage is bleeding affecting the midline region of the cerebellum. It is uncommon, accounting for 5-13% of all intracerebral haemorrhages. It is a grave condition with a high mortality. The diagnosis must be made early, if not, most patients would die within 48 hours. A 70-year-old lady presented to the accident and emergency department with a six hours history of sudden onset generalized tonic-clonic seizures following activity and loss of consciousness. She was unconscious with a Glasgow coma score of 3/15 with neck stiffness, generalized hypotonia and globally diminished reflexes. Her blood pressure was 240/120 mmHg with a mean arterial pressure of 160 mmHg. The brain computerized tomographic scan showed a hyperdense area in the cerebellar vermis with extension to both hemispheres and fourth ventricle. Consciousness was regained after three weeks of conservative management following which she became extremely restless and noticed to have developed titubations with nystagmus of both eyes. She also developed intention tremors, scanning dysarthria, generalized hypotonia, dysmetria, dysdiadochokinesia and intentional bilateral tremors. Her recovery was slow and gradual. Once she was able to stand with support, she was noticed to have florid truncal ataxia, lower limbs ataxia, and titubations.

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Section: Introductionmentioning

confidence: 99%

“…2 If hydrocephalus is the main cause of deterioration, a temporising ventriculostomy is performed. No further surgical therapy may be needed if the patient improves as was with the index case.…”

mentioning

confidence: 99%

Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

Iyagba

Onwuchekwa

2016

Int J Res Med Sci

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“…However, this method has several drawbacks such as greater degree of invasion, longer operating time, and postoperative liquorrhea and meningitis. 8,11,12,15) Therefore, stereotactic aspiration, 10,16) endoscopic evacuation, 18) freehand bedside catheter evacuation, 1) and minicraniectomy 15) have all been proposed. Reportedly, postoperative outcomes show no significant difference between patients subjected to mini-and large craniectomy.…”

Section: Discussionmentioning

confidence: 99%

“…6,8,11,12,14,17) SCH accounts for approximately 10% of all intracerebral hemorrhages. Patients with cerebellar hematomas larger than 3 cm in diameter may benefit from emergency surgical evacuation 2,5,7,17) because it is unwise to defer intervention until aggravation of their neurological condition renders them comatose.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Key Hole Craniotomy for the Evacuation of Spontaneous Cerebellar Hemorrhage

Tokimura

Tajitsu

Taniguchi

et al. 2010

Neurol. Med. Chir.(Tokyo)

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The efficacy and safety of cerebellar hemorrhage evacuation by key hole craniotomy and the importance of thorough evacuation and irrigation of the hematoma in the fourth ventricle to resolve obstructive hydrocephalus were assessed in 23 patients with spontaneous cerebellar hemorrhage (SCH) greater than 3 cm or with brainstem compression and hydrocephalus. A 5-cm elongated S-shaped scalp incision was made, and a 3-cm key hole craniotomy was performed over a cerebellar convexity area. The hematoma was immediately evacuated through a small corticotomy. The hematoma in the fourth ventricle was gently removed through the hematoma cavity, followed by thorough saline irrigation to release obstructive hydrocephalus. Patients classified retrospectively into favorable and poor outcome groups using the Glasgow Outcome Scale (GOS) scores of 4-5 vs. 1-3 showed significant differences with respect to the preoperative Glasgow Coma Scale, hematoma size and volume, and brainstem compression. Only 2 of the 23 patients required ventricular drainage and no postoperative complications were recorded. Patients treated by experienced and inexperienced surgeons showed no significant differences in the hematoma evacuation rate, postoperative GOS, and interval from skin incision to start of hematoma evacuation. Our simplified method of key hole craniotomy to treat SCH was less invasive but easy to perform, as even inexperienced neurosurgeons could obtain good surgical results. Thorough cleaning of the fourth ventricle minimized the necessity for ventricular drainage.

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“…Postoperative recurrent hemorrhage can be fatal (20,33), but death may also occur in patients treated conservatively (4). The most serious complication following posterior fossa AVM surgery is hemorrhage from residual fragments of an AVM or from insecure hemostasis.…”

Section: Yilmaz a Et Al: Ruptured Cerebellar Arteriovenous Malformatmentioning

confidence: 99%

The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of haematomas

Yılmaz¹,

Müslüman²,

Kanat³

et al. 2010

Turkish Neurosurgery

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AIm:The correlation between hematoma volume and outcome in ruptured arteriovenous malformations (AVM) with accompanying posterior fossa hematoma was retrospectively evaluated. mAterIAl and methOds: Microsurgery operations were performed on 127 patients with intracranial AVM between January 1998 and January 2009 at our clinic. Fifteen (11.8%) patients were identified as suffering from posterior fossa AVM, and twelve of these patients presented with a cerebellar hematoma. All patients were clinically evaluated according to the following criteria: modified Rankin Scale (mRS) prior to surgery, Spetzler-Martin grade (SMG) of the AVMs, hematoma volume prior to surgery, and mRS following surgery.results: Postoperative mRS scores were significantly lower than preoperative scores (p=0.0001). Postoperative outcomes were concordant with the SMG of the AVMs (r=0.67, p=0.033), hematoma volume (r=0.537, p=0.072) and preoperative mRS scores (r=0.764, p=0.004). These analyses show that the postoperative mRS score is strongly correlated with a preoperative mRS score, hematoma volume and SMG.COnClusIOn: Posterior fossa AVMs present an increased risk for hemorrhage and for increased morbidity and mortality. Cases with hematoma should be operated on an urgent basis. We conclude that hematoma volume is a factor that impacts postoperative results and prognosis. SMG and preoperative mRS scores were also correlated with outcome. BulGulAr: Postoperatif mRS skoru istatistiksel olarak anlamlı şekilde preoperatif skordan daha düşük bulundu (p=0,0001). Postoperatif klinik sonuç; AVM 'nin SMG'I (r=0,67, p=0,033), hematom volümü (r=0,537, p=0,072) ve preoperatif mRS (r=0,764, p=0,004) ile uyumlu bulundu. Nörolojik defisit AVM'nin SMG'i ile uyumlu şekilde artmış idi. İncelemeler göstermektedir ki, postoperatif mRS, preoperatif mRS, hematom volümü ve SMG ile daha fazla ilişkilidir. sOnuÇ: Posterior fossa AVM ler, kanama riski ile beraber artan morbidite ve mortalite riski taşıyan kompleks nörovasküler lezyonlardır. Hematomlu vakalar acil şekilde opere edilmelidir. Hematom volümü klinik sonuç ile ilişkidir. Biz hematom hacminin, postoperatif klinik sonuç ve prognoz üzerinde etkili bir faktör olduğu sonucuna vardık. Ayrıca preoperatif SMG ve mRS de klinik sonuç üzerinde etkilidir.

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Management of 50 spontaneous cerebellar haemorrhages

Cited by 51 publications

References 27 publications

Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

Efficacy and Safety of Key Hole Craniotomy for the Evacuation of Spontaneous Cerebellar Hemorrhage

The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of haematomas

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