Hypertensive cerebellar hemorrhage and cerebellar hemorrhage caused by cryptic angioma: analysis of clinical observations, CT findings and outcome.

Abstract

A series of 44 patients with hypertensive cerebellar hemorrhage and nine patients with cerebellar hemorrhage caused by small angiomas is described. Hypertensive hemorrhage occurred most frequently in the patients in their seventies, whereas the onset of angiomacaused hemorrhage was often seen below the age of 40. Clinical syndromes of cerebellar hemorrhages can be categorized into three basic types: the vertigo syndrome, cerebellar dysfunction syndrome and brain stem compression syndrome. Patients with small ( ≥2 cm in diameter in CT scans) and medium-sized (2 cm <3 cm in diameter) hematomas usually presented one of the former two syndromes with no or only mild impairment of consciousness. However, unless prompt surgical decompression was carried out, most patients with large ( ≥3 cm) hematomas deteriorated into unresponsive conditions and developed signs of brain stem compression. Surgical mortality was 32% in the hypertensive group, while it was 0% in the angioma group. Mortality as well as morbidity in both groups was strongly influenced by the preoperative status of consciousness. Our results suggest that substantial improvement could be obtained in the overall outcome of this disease by emergency craniectomy and removal of hematomas in all patients with large hematomas regardless of the levels of consciousness and regardless of the causes of bleeding. Furthermore, when clinical information and CT findings are suggestive of a “cryptic” angioma as the causative lesion, posterior fossa surgery may be indicated to extirpate the lesion, even if the hematoma is small.