Space-occupying cerebellar infarction. Clinical course and prognosis.

Hornig, C. R.; Rust, D. S.; Busse, O.; Jauß, M.; Laun, A.

doi:10.1161/01.str.25.2.372

Cited by 129 publications

(106 citation statements)

References 24 publications

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“…17 If a cerebellar infarction produces a mass effect with signs of brainstem compression or herniation, a surgical decompressive procedure may be necessary in such patients. 24,25 Although reported strokes associated with marijuana use are few, marijuana use may represent a genuine risk factor for stroke, especially in the adolescent and particularly in the cerebellar circulation.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use

2004

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ABSTRACT.Objective. To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients.Design. A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years.Setting. Inpatient and intensive care hospitalization units managing children and adolescents.Subjects. Male adolescent patients with ischemic cerebellar stroke after use of marijuana.Diagnostic Investigations. Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects).Results. Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures.Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity. Pediatrics 2004;113:e365-e370. URL: http://www.pediatrics.org/cgi/content/full/113/4/e365; ischemic stroke, cerebral blood flow, marijuana, adolescent drug use.

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Section: Discussionmentioning

confidence: 99%

Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use

2004

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“…11,14,26 The majority of patients also have hypertension. 13,26 The infarction most frequently occurs in the vascular distribution of the posterior inferior cerebellar artery, but the anterior inferior cerebellar artery and/ or superior cerebellar artery territories can also be involved. 14,26 Cerebellar infarctions are approximately two-thirds as common as cerebellar hemorrhage.…”

Section: Pathophysiology and Natural Historymentioning

confidence: 99%

“…25 In its mild form, deterioration manifests as irritability, confusion, or somnolence, while the more severe form presents as coma, stupor, posturing, and hemodynamic or respiratory instability due to loss of brainstem regulation. 13 The peak incidence of deterioration is 3 days after onset, although it may occur within hours or even weeks later. When deterioration occurs, mortality has been reported to be high (25%-100%), regardless of treatment.…”

mentioning

confidence: 99%

“…The range of time that can elapse between symptom onset and further neurological deterioration is typically 1-7 days, with a median and mode of 3 days. 5,13,14 However, the likelihood of deterioration has been reported to be lower in cerebellar infarct (7%-32%) than in hemorrhage. 1,14 Whereas hydrocephalus and brainstem compression can both cause decreased level of consciousness, the latter is alleged to have associated focal neurological signs.…”

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confidence: 99%

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Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Amar

2012

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Evidence-based guidelines for the management of hemorrhagic and ischemic cerebellar stroke are sparse, and most available data come from Class III studies. As a result, opinions and practices regarding the nature and role of neurosurgical intervention vary widely. A comprehensive literature review was conducted to adjudicate several contentious issues, such as the difference in the management of cerebellar hemorrhage versus infarction, criteria for imaging to exclude an underlying structural lesion, the value of MRI for patient selection, the role of external ventricular drainage, the indications for operative management, the timing of surgical intervention, and various options of surgical technique, among others. Treatment algorithms proposed in several different studies are compared and contrasted. This analysis is concluded by a summary of the recommendations from the American Stroke Association, which advises that patients with cerebellar hemorrhage who experience neurological deterioration or who have brainstem compression and/or hydrocephalus due to ventricular obstruction should undergo surgical evacuation of the hemorrhage as soon as possible, and that initial treatment of such patients with ventricular drainage alone rather than surgical removal of the hemorrhage is not recommended.

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“…If hydrocephalus is present, CSF drainage via an intraventricular catheter can rapidly lower ICP. In a prospective case series, surgical, decompressive therapy in hemispheric spaceoccupying infarction lowered mortality from 80% down to 30% without increasing the rate of severely disabled survivors 216,279,295 . Early decompressive surgery within the first 24 h after stroke onset can reduce mortality even more markedly 295 .…”

Section: Decompressive Surgerymentioning

confidence: 97%