Predictors of Neurological Deterioration during Admission for Patients with Cerebellar Strokes

Abstract

Objective: Despite less common, cerebellar stroke frequently results in unfavorable outcomes, especially after deterioration. Therefore, this study was aimedto identify the significant predictors of neurological deterioration during admission (NDDA) in ischemic and hemorrhagic cerebellar strokes.Material and Methods: We retrospectively reviewed all medical records of patients diagnosed with ischemic and hemorrhagic cerebellar strokes; during 2002-2018, in Songklanagarind Hospital. Comparison of patients’ demographic data, initial clinical presentations, neuroradiological results, timing and signs of NDDA, and outcomes between cerebellar strokes were descriptively analyzed. Logistic regression model was applied for determining the significant predictors of NDDA from initial clinical presentations.Results: From this, 74 of 100 patients were eligible. They comprised of 42 (57.0%) cerebellar ischemia (CI) and 32 (43.0%) cerebellar hemorrhage (CH). Elevated diastolic blood pressure (DBP) and neuro-radiological evidences suggesting increased posterior cranial fossa pressure were significantly prevalent in neurological deterioration patients. NDDA was found in 31 patients (42.0%), without significant difference between CI and CH. 42 (56.8%), patients had poor neurological outcomes. The independent predictors for NDDA were DBP 120 mmHg (adjusted odds ratio [adj. OR] 15.39, 95% CI 1.58- 149.59; p-value=0.004), time from onset to arrival (adj. OR 0.98, 95% CI 0.97-1.00; p-value=0.044), and hemispheric cerebellar signs at presentation (adj. OR 0.22, 95% CI 0.06-0.75; p-value=0.012).Conclusion: CH was not an independent predictor of NDDA in overall cerebellar strokes. Only high DBP predicted NDDA; whereas, time from onset to arrival, and hemispheric cerebellar signs at presentation showed protective impact.