Surgical management of acute cerebellar infarction

Abstract

After reviewing the literature, a personal series of 10 adult patients with cerebellar infarction diagnosed by CT scan is described. The clinical picture in young adult men is characterized by rapid onset of headache, vomiting, vertigo, ataxia and blurred vision. After this sudden onset the patients may present a stable course or a rapid or delayed onset of brain stem compression, revealed by impairment of consciousness. CT scan is the diagnostic method of choice. The correlation between angiographic and CT localization of the infarction is not good. For therapy the following policy is suggested: in alert and clinically stable patients: medical treatment (mannitol, glycerol, dexamethason), ICP and serial CT monitoring; in alert patients with hydrocephalus or mass effect: medical treatment and monitoring as mentioned before; ventricular drainage if ICP surpasses 350 mm H2O; in patients with impaired consciousness and hydrocephalus or mass effect: immediate ventricular drainage. If it is not followed by prompt improvement of the level of consciousness, an emergency suboccipital craniectomy with removal of the infarcted tissue should be done.

Therapeutic Strategies in Space-Occupying Cerebellar Infarction Based on Clinical, Neuroradiological and Neurophysiological Data

“…In agreement with Cioffi et al [2], Kazner et al [42] and Perneczky and Ungersbock [43] we favor gradual therapeutic procedures. The preliminary data of this study suggest decompressive craniotomy as the most effective therapy in comatose patients, whereas in awake or drowsy patients medical therapy or ventriculostomy in the event of hydrocephalus combined with careful neuro physiological and neuroradiological monitoring is suffi cient.…”

Long-Term Outcome After Surgical Treatment for Space-Occupying Cerebellar Infarction

“…13,29 The rationale is that deterioration of consciousness in most patients with space-occupying cerebellar stroke is primarily attributable to obstructive hydrocephalus. 11,13 Other authors, however, consider ventriculostomy alone as dangerous in these patients, first because of the risk to induce upward herniation (whereas others consider this risk as overestimated) and second because it does not undo brain stem compression, especially when mass effect is still increasing.…”

Infarto cerebelar: análise de 151 pacientes

“…Na casuística re t rospectiva de pouco mais de 10 anos, a isquemia cerebelar mostrou-se sensivelmente mais prevalente nos homens e nas pessoas maiore s de 40 anos de idade como já observado em outro s trabalhos 4,5,7 .…”

“…O fato das isquemias cere b e l a res, em tantas vezes e s t a rem associadas a infartos em outras zonas do encéfalo e a ocorrência de expressivo número de infartos após procedimentos cardiológicos invasivos faz concluir que o principal mecanismo causador de inf a rto cerebelar seja fenômeno cardio-embólico decorrente de procedimento cirúrgico 1,3,5 .…”

“…Porém, quando maciça pro p o rc i o n a aumento da pressão no compartimento da fossa posterior com herniação sobre o tronco encefálico e sua conseqüente isquemia, além de subseqüente aumento supratentorial da pressão intracraniana, devido a oclusão do IV ventrículo e hidrocefalia [1][2][3][4][5][6][7][8] .…”