Recurrent Cerebellar Hemorrhage: Case Report and Review of the Literature

Abstract

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.

Volume Quantification of Acute Infratentorial Hemorrhage with Computed Tomography: Validation of the Formula 1/2ABC and 2/3SH

“…Several studies had validated that, when transverse diameter >2 cm or volume >5 ml, 30-day mortality rate of patient with brainstem hemorrhage was very high and suggested surgical treatment such as stereotactic surgery or microsurgery [29], [30], [31], [32]. For cerebellar hemorrhage, surgery was also recommended when volume >15 ml or maximal transverse diameter >3 cm [9], [10], [11], [12], [13]. Hence, a simple yet reliable estimation technique for hematoma volume is very important in clinical practice.…”

“…ICH-Score, ICH-GS, and some other clinical grading scales for ICH prognosis, are all based on hematoma volume estimate [7], [8]. Some researchers recommend surgeries for cerebellar hemorrhage if volume >15 ml or maximal transverse diameter >3.0cm [9], [10], [11], [12], [13]. Furthermore, hematoma volume can also predict the prognosis of pediatric spontaneous intracerebral hemorrhage [14], [15], [16].…”

Cerebellar Stroke

“…However, it does not seem necessary for cerebellar hemorrhages to have very high levels of blood pressure. In the report by Terayama et al (1997), the average blood pressure of cerebellar hemorrhage patients at the time of onset was about 125 mmHg in fatal cases and 115 mmHg in nonfatal cases, whereas the major cause of recurrent cerebellar hemorrhages was irregular control of blood pressure (Wu et al 2010). Amyloid angiopathy is one of the causes of cerebellar hemorrhage, but its incidence is likely to be low, because cerebellar hemorrhage frequently occurs under the age of 60 (Itoh et al 1993).…”

Cerebellar Glioblastoma Multiforme Presenting as Hypertensive Cerebellar Hemorrhage: Case Report

“…Long-standing hypertension with degenerative changes in the vessel walls and subsequent rupture is believed to be the most common cause of a typical cerebellar hemorrhage. 10,13,28 Blood dyscrasias, amyloid angiopathy, arteriovenous malfor-mations, trauma, and sympathomimetic abuse are less common causes of cerebellar hemorrhage. Cerebellar hemorrhages have been reported to be rare in patients after supratentorial or spinal surgery and in patients with spontaneous intracranial hypotension.…”

“…Brainstem damage by compression from an expanding mass in the posterior fossa is a common and feared complication. 18,28,30 Suprasellar GBMs have a known propensity for bleeding. 11,32 Furthermore, as noted earlier, cerebellar hypertensive hemorrhage is frequently encountered in neurosurgical practice.…”