Cases Of Cerebellar Hemorrhage Research Articles

Cerebellar hemorrhage in patients treated with edoxaban for portal vein thrombosis after hepatobiliary surgery: a report of two cases

BackgroundThe standard therapeutic agent administered for portal vein thrombosis (PVT) in patients with or without cirrhosis is warfarin or low-molecular weight heparin. However, therapy with edoxaban appears to be one of the most promising treatments for patients who require anticoagulation therapy. We encountered two cases of cerebellar hemorrhage in patients treated with edoxaban for PVT after hepatobiliary surgery during the past 2 years.Case presentationCase 1 A 67-year-old male underwent cholecystectomy and choledocholithotomy with choledochoduodenostomy to treat choledocholithiasis after cholangitis. Enhanced computed tomography (CT) on the 1st postoperative day (POD) revealed thrombosis in the left and anterior segment of the portal vein branches. We administered antithrombin III concentrate with heparin for 5 days; thereafter, we switched to 60 mg edoxaban. A sudden decrease in the patient’s level of consciousness was observed due to cerebellar hemorrhage on POD 27. Cerebellar hemorrhage was successfully treated with craniotomy hematoma evacuation and ventricular drainage; however, the patient died from aggravation of hepatic failure due to PVT and intra-abdominal infection. Case 2 A 67-year-old male received laparoscopic microwave coagulation therapy for two hepatic nodules suggestive of hepatocellular carcinoma in the left lobe of the liver due to alcoholic hepatitis. Enhanced CT on POD 5 revealed a thrombosis in the 4th segment branch of the portal vein, and the patient was treated with 60 mg edoxaban. Cerebellar hemorrhage with ventricular perforation occurred on POD 15. Cerebellar hemorrhage was successfully treated by craniotomy hematoma evacuation with ventricular drainage. Prolonged consciousness disorder persisted, and the patient was transferred to another medical facility for rehabilitation 49 days after brain surgery.ConclusionsAlthough edoxaban is recently described to be one of the options for patients with PVT who require anticoagulation therapy instead of heparin or warfarin, it should be used with caution, given its propensity to induce severe hemorrhagic adverse events in cases such as those described above. The monitoring of hepatic dysfunction and decision for continuation of drug may be required during edoxaban use for PVT, especially after hepatobiliary surgery.

A case of cerebellar hemorrhage in a patient with severe dengue

Background: Degue is the most rapidly spreading mosquito-borne viral infection in the world with various symptoms and clinical presentation. Neurological complication of dengue is rare (0.5 to 7.4%) and its pathophysiological basis of is not fully understood. Data on cerebellar hemorrhage as a complication of severe dengue is rare. Case Description: This is a case of a 25 y old female, household helper presented with a 5 d history of fever, headache, nausea, vomiting and diarrhea. She consulted a physician, diagnosed was acute gastroenteritis, advised supportive care. Workups showed leukopenia, thrombocytopenia, positive dengue NS1Ag. She was hydrated intravenously at home. In 2 d, platelet count further decreased and transaminases were elevated. On the 5th day of illness, fever and diarrhea resolved, but was noted disoriented. At the ER, vital signsBP 100/70 mmHg, CR 78, RR 26, temperature 36.5C, GCS13 (E3V4M6) with petechiae on both upper extremities. Manual muscle and sensory testing were normal but unable to do finger to nose test, no meningeal and Babinski signs. Repeat workups showed leukocytosis (22.70 x 109/L), thrombocytopenia (47.00 x 109/L). She was hydrated with PNSS and started on cefepime and moxifloxacin to cover for a possible pneumonia. She was noted to be unresponsive and was intubated. ET secretion was frothy. Other workups: 12LECG sinus tachycardia with anterior wall ischemial; chest X-ray pulmonary edema; cranial CT scan showed cerebro-cerebellar edema with uncal herniation, non-communicating hydrocephalus with possible subarachnoid hemorrhage. Her blood pressure decreased requiring vasopressors. She was to be transfused with platelet concentrate, when she had cardiac arrest and attempted resuscitation 3 times. Patient eventually expired. Post-mortem examination showed pulmonary congestion (right lung 700 g, left lung 750 g); pleural effusion (right 300 mL light red, thin fluid), cerebellar hemorrhage and gastric pinpoint hemorrhages. Discussion: Prevalence of hemorrhage on dengue, especially in the central nervous system, especially in the cerebellum is rare. Further studies may be done to determine certain risk factors that may be predict such complications. Conclusion: We were able to present a case of severe dengue presenting with cerebellar hemorrhage and circulatory collapse and exemplified that these cases possessed high mortality despite early diagnosis.

喉頭気管食道瘻閉鎖術後に喉頭挙上・食道入口部開大の悪化を呈した小脳出血・嚥下障害の1症例

喉頭気管食道瘻閉鎖術後に喉頭挙上・食道入口部開大の悪化を呈した小脳出血・嚥下障害の1症例

Opsoclonus-myoclonus-ataxia syndrome presenting in Enugu, Southeast Nigeria: A case report

Opsoclonus – myoclonus- ataxia syndrome is an extremely rare neurological condition of probable autoimmune aetiology. It has not been previously described in medical literature from Nigeria and West Africa. This is a case report of a 43- year old Nigerian woman who presented to the University of Nigeria Teaching Hospital Enugu Emergency Department in July 2018 with a 5 weeks history with vertigo, diplopia, dancing eyes, muscular twitches and incoordination two weeks after a caesarean section complicated by intra-operative bleeding. No other significant medical history. She had been managed as a case of cerebellar haemorrhage before referral to the Neurology Unit. On examination she was lucid, had normal vital signs, opsoclonus, motor ataxia and myoclonus affecting the left face as well as left upper extremity. Investigations done were normal except for reduced cerebrospinal fluid ( CSF) protein. Her symptoms responded substantially to prednisolone and clonazepam. The relevant literature was reviewed. Opsoclonus myoclonus ataxia syndrome though rarely described in Africans may occur and may be misdiagnosed by inexperienced physicians leading to undesirable consequences.

血友病例における脳静脈性血管奇形に伴う若年性小脳出血の1 例

血友病例における脳静脈性血管奇形に伴う若年性小脳出血の1 例

PO-0462 Cerebellar Haemorrhage In The Preterm Infants In A University Regional Tertiary Neonatal Unit: Ultrasonographic And Clinical Risk Factors: Abstract PO-0462 Table 1

Background Cerebellar haemorrhages (CBH) are increasingly recognised in extremely preterm infants with advances in early ultrasound neuroimaging. Information on incidences, risk factors, mortality and neurodevelopmental sequelae remains limited. Aim To investigate the incidence of cerebellar haemorrhage in preterm infants diagnosed by ultrasound and identify risk factors and outcomes in a Tertiary Neonatal Intensive Care Unit. Methods Preterm infants with cerebellar haemorrhage over 5 years (January 2009 to December 2013) were identified from a systematic electronic radiological database. Cases of cerebellar haemorrhage were diagnosed by cranial-ultrasound using the mastoid window and detailed medical record reviews were done. Results A total of 13 cases were identified to have cerebellar haemorrhages (2641 infants Conclusion In our study cerebellar haemorrhages is predominantly seen in the extreme preterm infants. It is associated with high mortality and predictors of risk factors appear to be multifactorial and include early postnatal haemodynamic factors. Early diagnosis and developmental follow-up help to identify infants with highest risk of developing long-term neurodevelopmental sequelae.

A contrast study on the curative effect between trepanation and drainage and decompressive craniotomy for treating cerebellar hemorrhage

Thirty-three cases of hypertensive cerebellar hemorrhage were involved in this survey, with the bleeding volume over 10 ml. All of them were given external ventricular drainage and then taken continuous monitoring of intracranial pressure (ICP) after admission. Within 7-24 h after the onset, they all underwent trepanation and drainage under local anesthesia. In the same period, another 33 cases of cerebellar hemorrhage patients were collected as the control, who met the inclusion criteria and were treated with conventional posterior fossa decompressive craniotomy. As results, the total efficiency of the drilling group was 81.82% (27/33), which was much better than the control group (63.64%, 21/33). However, there was no statistical significance between 2 groups (χ 2 = 2.750, P = 0.097). doi: 10.3969/j.issn.1672-6731.2014.06.014

回転性めまいと耳鳴を主訴とした小脳出血の一例

回転性めまいと耳鳴を主訴とした小脳出血の一例

A CASE OF ‘PING–PONG’ GAZE OF UNKNOWN CAUSE

A 66 year-old Indian gentleman with a background of type II diabetes, Crohn's disease and previously treated tuberculosis presented with double vision and unsteadiness.He was found to have a right-sided...

腰椎手術後に小脳出血をきたした1例

腰椎手術後に小脳出血をきたした1例

Cerebellar haemorrhage in the extremely preterm infant

The aim of this study was to investigate the incidence, risk factors and developmental outcomes of cerebellar haemorrhage in the extremely preterm infant. Over a 4-year period from January 2004, all patients with cerebellar haemorrhage born at 24-27 weeks gestation or with a birthweight < 1000 g were identified from database review. All patients had cranial ultrasound scans including views from the mastoid fontanelle. To verify the incidence, a review of all reports over the 4-year period and a review of all cranial imaging over a 2-year period were carried out. From the data analysed on 339 neonates, five cases of cerebellar haemorrhage were identified, four on ultrasound scan (1.2%) and one on magnetic resonance imaging (1.5% total). Two cases were associated with grade III peri-intraventricular haemorrhage. The cases had diverse maternal, antenatal and post-natal risk factors. The two with associated peri-intraventricular haemorrhage have developmental delay. The cases with isolated cerebellar haemorrhage had good neurodevelopmental outcomes. A low incidence of cerebellar haemorrhage identified from the mastoid fontanelle was demonstrated. The neurodevelopmental outcome was better than that described in previous reports.

Recurrent Cerebellar Hemorrhage: Case Report and Review of the Literature

We report a case of cerebellar hemorrhage (CH) that recurred in other hemisphere after 4months of the first attack. A 58-year-old man presented with general weakness and computerized tomography (CT) of the brain showed a 41mm hematoma in the right cerebellum with intraventricular extension. The satisfactory outcome was obtained after emergency surgical intervention and intensive rehabilitation. However, the patient irregularly took the prescribed anti-hypertensive medication. Four months after first attack, the recurrent CH in left side showed by brain CT. Only 2 cases of recurrent CH have been published thus far. The patient is the third reported case of recurrent CH and the second case in which CH recurred in the other hemisphere. Further, no patient has been reported to develop recurrence of CH in such a short period after the first onset. We discuss the possible pathophysiology, clinical course, treatment outcome, risk factors associated with such events and the importance of blood pressure control for preventing recurrence.

An unusual case of cerebellar hemorrhage in a patient with systemic lupus erythematosus

An unusual case of cerebellar hemorrhage in a patient with systemic lupus erythematosus

Remote Cerebellar Hemorrhage and Iliofemoral Vein Thrombosis After Supratentorial Craniotomy

Cerebellar hemorrhage following supratentorial craniotomy is rare. Its clinical symptoms are often mild and transient. Here, we report a case of cerebellar hemorrhage associated with iliofemoral vein thrombosis as a complication of anterior temporal lobectomy and amygdalohippocampectomy for refractory medial temporal epilepsy.

Hemorragia cerebelosa en recién nacidos a término

Cerebellar hemorrhage (CH) has been observed in 5 to 10% of the autopsies done on newborn babies. Since neuroimaging techniques have become available it is easier to diagnose the condition. In this paper we report on a series of cases of CH in full-term newborn babies. To determine the number of patients with CH diagnosed by neuroimaging, make a descriptive study and analyze their progress. Between 1984 and 1999 six patients had CH, three boys and three girls, five born after their mother's first pregnancy. Four were vaginal births; in two forceps were used and in one a vacuum extractor; two were born by cesarean section. Four showed symptoms within the first 48 hours of life, one on the fourth day and one on the twenty fifth day. The latter had hemorrhagic disease of the newborn. In five patients transfontanellar ultrasound was useful in diagnosis. In all six cases computerized axial tomography scan confirmed the diagnosis. Cerebral magnetic resonance (MR) was done in three cases. No arteriovenous malformations were shown on angio-MR. Two patients had hydrocephalus and both were treated by ventriculo-peritoneal shunts. Three cases had transient ventricular dilatation which improved with medical treatment. The patient with hemorrhagic disease of the newborn had alterations in blood clotting. In three patients metabolic studies were normal. Five patients were treated conservatively and only one neurosurgically. Subsequent evolution was characterized by the presence of psychomotor retardation with mild cerebellar signs. At school age, only observed in two cases, there were learning difficulties with a low intellectual coefficient and problems with reading and writing. In one case there was epilepsy, controlled by use of two antiepileptic drugs. Half the cases of CH transfontanellar ultrasound is useful in diagnosis. Most patients were managed conservatively. During the clinical course there were psychomotor retardation, cerebellar signs, cognitive deficits with learning problems and epilepsy.

破裂脳動脈瘤術後に小脳出血をきたした3例の検討

We present three cases of cerebellar hemorrhage following aneurysmal surgery for the anterior communicating artery.Postoperative cerebellar hemorrhage located remotely from the supratentorial site is a rare complication. In a review of the literature, we identified 29 such cases, including 23 cases of aneurysmal surgery. We examined the possible etiologies for cerebellar hemorrhage in these reports. Almost all the reports described CSF overdrainage by epidural suction, causing cerebellar hemorrhage. These cases showed a specific configuration in which the hematoma spread transversely along the cerebellar folia and strictly curvilinearly on CT scan. The location of this hematoma consisting with the position of cerebellar hemispheric bridging veins.We suggest that the mechanism of this complication is dislocation of the dependent part of the cerebellum, and destruction of the bridging veins on the tentorial surface causing CSF overdrainage.The strict management of draining is important to prevent this complication.

未破裂眼動脈瘤術後に小脳出血と長期にわたる開頭側脳腫脹をきたした1例

未破裂眼動脈瘤術後に小脳出血と長期にわたる開頭側脳腫脹をきたした1例

Influence of Cerebellar Hemorrhage on the Higher Cerebral Functions

It has been observed since long that the cases of cerebellar hemorrhage often had the difficulty of rehabilitation not only by a truncal ataxia but also by a retarded intelligence, a loss of volition and a decreased attention span. The authors investigated 7 cases of operated cerebellar hemorrhage of moderate size on how they were disturbed on the higher cerebral functions by applying them WAIS and other several neuropsychological test batteries. The frontal lobe functions were examined by the original test batteries of our design. As the results, there was the moderate or severe decrease of WAIS on all 7 cases and also marked disturbance of the frontal lobe functions on 4 cases excluding 3 unapplicable cases. The above results will suggest anyhow that the cerebellar damage around the dentate nucleus would give rise the disturbance of generalized higher cerebral functions, though its mechanism has not not been elucidated. It would be very important for us now on to examine extensive higher cerebral function on those cases of cerebellar hemorrhage.

Acute cerebellar hemorrhage with brainstem compression in contrast with benign cerebellar hemorrhage

Twenty six cases of cerebellar hemorrhages were reviewed and analyzed. Two patients were comatose on admission and showed clinical evidence of brainstem compression; they were successfully revived after evacuation of the hematomas. This was in contrast with six other comatose patients who did not have evacuation and subsequently died within 48 hours. The other eight cases of so-called benign cerebellar hemorrhage ran a more benign course and recovered without any operative procedures. It is suggested that prompt diagnosis with computed tomography, even in comatose patients, and immediate removal of the hematoma in this group, might result in a better prognosis with this highly lethal condition.

Conserative treatment of hypertensive cerebral hemorrhage: results of 104 patients of acute stage (author's transl)

Mortality and morbidity are reviewed in cases of cerebral hemorrhage patients who were transported to and were treated conservatively at the Research Institute of Brain and Blood Vessels, Akita, from May, 1969 through April, 1974. Of 104 cases, there were 85 cases with hematoma of basal ganglia, 15 cases of pontine hemorrhage, and four cases of cerebellar hemorrhage. Of the total 74 cases (71%) were admitted within the first day of stroke. The level of consciousness on admission was semicomatose or comatose in 54 cases (52 %). Most of the cases were transported to the hospital by a hospital ambulance with a doctor, and a nurse as soon as possible after the onset of stroke. Patients were treated in the NCUs (Neurovascular Care Units) or sub-NCUs, depending on the type of stroke and the severity. The survival rates within one month in the hospital was 59 % for patients with hematoma of basal ganglia, 27 % for patients with pontine hemorrhage, and none for patients with cerebellar hemorrhage, or 52 % for all 104 cases. One-month survival rates was 39 % for cases admitted within the first day of attack, 78 % for those transported between two to three days, 87 % for cases admitted between four to seven days, and 100 % for those transported between eight to fourteen days, following stroke. Among 104 cases, 12 cases (11 %) died within the first day after the attack, 37 cases (35 %) within seven days, 50 cases (48 %) within one month, 54 cases (52 %) within six months, and 58 cases (56%) within one year following the stroke. Survival rates of one week, one month, six months, and one year, were 41 %, 20 %, 17 %, and 13 %, respectively, in the semicomatose or comatose patients group, 86 %, 81 %, 76 %, and 73 %, respectively, in the somnolent or stuporous patients group. All cases but one, who died of other than cerebrovascular disease, survived in the group with clear consciousness upon admission. Therefore, it can be concluded that there is good correlation between the level of consciousness upon admission and the prognosis in this series. Morbidity of one year after the onset in 50 patients who survived more than one month, are as follows : eleven patients improved well enough to live and work without any difficulty, sixteen were capable of taking care of themselves in dialy chores, but incapable of work, eight needed on other's aid, nine were confined to their beds, and six patients died. Patients who were in disturbed consciousness three months following cerebral hemorrhage, could not get alert both six months and one year after the incident of apoplexy. Of 50 survivers with basal ganglionic hemorrhage, four cases (8 %) were in akinetic mutism or apallic state. All survivors with pontine hemorrhage were always in the state of akinetic mutism. Of 50 autopsies, 42 cases (84 %) of complicated ventricular bleeding were observed, 19 cases (38%) of uncal or cingulate or tonsillar herniation, and 13 cases (19%) of pontine bleeding secondary to basal ganglionic hemorrhage. The incidence of systemic complications in 50 autopsied cases were gastrointestinal abnormalities (61%), pneumonia (23%), and urinary tract infection (19 %). In other words, complications were found most markedly in the gastrointestinal tract and frequency of infections appeared to be relatively lower.