Traumatic Intracerebellar Hemorrhage: Clinicoradiological Analysis of 81 Patients

Abstract

This study describes clinicoradiological findings and prognostic factors regarding traumatic cerebellar injury. A general consensus emerged from this analysis that a conservative approach can be considered a viable, safe treatment option for noncomatose patients with intracerebellar clots measuring less than or equal to 3 cm, except when associated with other extradural or subdural posterior fossa focal lesions. Also, a general consensus was reached that surgery should be recommended for all patients with clots larger than 3 cm. The pathogenesis, biomechanics, and optimal management criteria of these rare lesions are still unclear, and larger observational studies are necessary.

Acute Posterior Cranial Fossa Hemorrhage—Is Surgical Decompression Better than Expectant Medical Management?

“…This may be related to the withdrawal of care as a response to severe brain injury. This trend is also seen in other patient cohorts, for example, in traumatic brain injury [20]. Longer ICU stay in surviving surgical patients was likely due to surgical recovery time and prolonged weaning from mechanical ventilation [24].…”

“…This guidance has been developed largely from observational and retrospective studies, some of which supports EVD as a viable independent treatment option [19]. These interventions are dependent on institutional guidelines focusing on the degree of 4 th ventricle occlusion [20] or hematoma dimensions [2]. A strategy focussed solely on EVD may be ineffective compared to SDC in the management of PCF hemorrhage.…”

“…This approach could introduce errors due to partial volume effects and beam-hardening artifacts. The results of our study cannot be generalized to other posterior fossa pathologies including traumatic and spontaneous subarachnoid hemorrhage [20]. …”

An atypical case of head trauma with late onset of contrecoup epidural hematoma, cerebellar contusion, and cerebral infarction in the territory of the recurrent artery of Heubner

“…4 They found that the factors for poor outcome were GCS score at admission (< 8) and a coexisting supratentorial traumatic lesions. Our patient with delayed cerebellar contusion had a good admission GCS score of 13 and relatively mild concomitant contrecoup supratentorial epidural hematoma, which may explain the good outcome.…”

“…[4][5][6]8,10,13,19,21,25 The prognostic factors for cerebellar contusion have been reported to be Glasgow Coma Scale (GCS) score at admission and concomitant presence of supratentorial lesions. 4 Most of the concomitant supratentorial lesions were contralateral acute subdural hematoma and cerebral contusion. Furthermore, delayed traumatic intracerebellar hematoma has been reported previously.…”