Recurrent, sequential, bilateral deep cerebellar hemorrhages: a case report

Abstract

IntroductionHypertensive intra-cerebral hemorrhage is usually a one-time event and recurrences are rare. Most recurrences develop as part of long-term failure of blood pressure control. The site of the re-bleed is usually limited to the basal ganglia and thalami.Case presentationWe report the case of a 59-year-old hypertensive Caucasian woman who developed two sequential, right- and then left-sided, deep cerebellar hemorrhages. The second hemorrhage followed the first one by 57 days, at a time when her blood pressure was optimally controlled. In spite of these critical sites and short duration between the two bleeds, the patient achieved a relatively good functional recovery. Her brain magnetic resonance angiogram was unremarkable.ConclusionThe development of recurrent hypertensive hemorrhage is rare and usually occurs within two years of the first bleed. To the best of our knowledge, this is the first reported case of bilateral, sequential, right- and then left-sided deep cerebellar hemorrhages. These hemorrhages were separated by eight weeks and the patient had a relatively good functional recovery. We believe that hypertension was the etiology behind these hemorrhages.

Left Ventricular Hypertrophy: a Comparison Among Kurdish Patients with First-ever Ischemic Versus First-ever Hemorrhagic Stroke

“…[23] As for the hemorrhagic stroke, it has been suggested that the presence of LVH is a mere marker of chronic hypertension and wide-spread end-organ damage, including intracerebral Charcot-Bouchard microaneurysm formation and rupture. [16,24,25] According to Di Tullio and colleagues, [26] LVH appeared to be independently associated with stroke, regardless of the age, sex, and ethnicity of the target population, and this is consistent with our observations. However, the increased prevalence among our Kurdish hemorrhagic stroke patients needs further analysis.…”

Conservative management in a rare case of spontaneous bilateral cerebellar haemorrhage

“…Poorly controlled blood pressure may lead to sequential haemorrhage in the cerebellum leading to bilateral haematoma due to rupture of Charcot–Bouchard micro-aneursyms 9. In the cerebellum, small penetrating branches arising from superior cerebellar arteries are the usual site of such micro-aneurysms which occur because of the degenerative effect of long-standing hypertension.…”

Recurrent hypertensive intracerebral haemorrhages: what should we do when a new hemispheric ischaemic event strikes?

“…We reported on this patient previously2 and we found that her blood pressure was well controlled after developing her very first primary ICH. Her examination notes stated that the patient's blood pressure was again well controlled with antihypertensive medications after developing the second cerebellar haemorrhage.…”