Cerebellar Contusion Research Articles

Prognostic and morphological factors in pediatric cerebellar contusions.

Although uncommon, cerebellar contusions are associated with significant morbidity and mortality. Literature is lacking in the prognostic and morphological factors relating to their clinical picture and outcomes, especially within children. The objective of this study is to evaluate prognostic and anatomic factors in the clinical picture of cerebellar contusions, including effacement of the 4th ventricle and cisterna magna. This is a retrospective chart review over 11 years across two medical centers. Patients included were under 18 years who presented with a cerebellar contusion. Patients were stratified within the study group based on discharge Glasgow outcome scale (GOS) and reviewed for prognostic factors contributing to outcome. Mid sagittal area of the 4th ventricle and cisterna magna were measured using magnetic resonance imaging and compared within the groups. A total of 21 patients met the study criteria, of which 16 (76.2%) were male, with an average patient age of 8.65 years. Poor outcome at discharge (GOS <4) was associated with decreased admission Glasgow coma scale (P = 0.003), admission motor response (P = 0.006), pupil reactivity (P = 0.014), presence of concomitant subarachnoid hemorrhage (P = 0.010), contusion volume (P < 0.001), and decreased area of the cisterna magna (P = 0.012). Patients with poor outcomes were also more likely to require surgical intervention (P = 0.042). There are multiple prognostic factors associated with the overall outcome following cerebellar contusions. The rate of good outcomes in this study was superior to that in previous studies in adults.

Supratentorial cerebrospinal fluid diversion using image-guided trigonal ventriculostomy during retrosigmoid craniotomy for cerebellopontine angle tumors.

Cerebellar contusion, swelling and herniation is frequently encoutered upon durotomy in patients undergoing retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors, despite using standard methods to obtain adequate cerebellar relaxation. The aim of this study is to report an alternative cerebrospinal fluid (CSF)-diversion method using image-guided ipsilateral trigonal ventriculostomy. Single-center retro- and prospective cohort study of n = 62 patients undergoing above-mentioned technique. Prior durotomy, CSF-diversion was performed to the point where the posterior fossa dura was visibly pulsatile. Outcome assessment consisted of the surgeon's intra- and postoperative clinical observations, and postoperative radiological imaging. Fifty-two out of n = 62 (84%) cases were eligible for analysis. The surgeons consistently reported successful ventricular puncture and a pulsatile dura prior durotomy without cerebellar contusion, swelling or herniation through the dural incision in n = 51/52 (98%) cases. Forty-nine out of n = 52 (94%) catheters were placed correctly within the first attempt, with the majority of catheter tips (n = 50, 96%) located intraventricularly (grade 1 or 2). In n = 4/52 (8%) patients, postoperative imaging revealed evidence of a ventriculostomy-related hemorrhage (VRH) associated with an intracerebral hemorrhage [n = 2/52 (4%)] or an isolated intraventricular hemorrhage [n = 2/52 (4%)]. However, these hemorrhagic complications were not associated with neurological symptoms, surgical interventions or postoperative hydrocephalus. None of the evaluated patients demonstrated radiological signs of upward transtentorial herniation. The method described above efficiently allows CSF-diversion prior durotomy to reduce cerebellar pressure during retrosigmoid approach for CPA tumors. However, there is an inherent risk of subclinical supratentorial hemorrhagic complications.

Traumatic midline cerebellar contusion in 2-year-old male child\u2014case report and review of literature

BackgroundCerebellar contusion accounts for 0.54% of traumatic brain injuries. They present with a variety of symptoms like ataxia, dysmetria, dysdiadokinesia, and vertigo. CT scan is the gold standard investigation for diagnosing acute cerebellar contusions. Due to the low incidence of this disease, there are no medical guidelines available for the management of cerebellar contusions.Case reportA 2-year-old child presented to the emergency department with altered level of consciousness. Computed tomography scan of the brain showed midline cerebellar contusion. He was managed conservatively with the main focus on lowering intracranial pressure.ResultCerebellar contusion can be managed conservatively with close monitoring. However, more data is needed to study its behaviour and management.ConclusionsThe patient had an excellent response to treatment and was discharged within a few days further highlighting the role of medical management in the treatment of patients with cerebellar contusions.

Surgical Treatment for Occipital Condyle Fracture, C1 Dislocation, and Cerebellar Contusion with Hemorrhage after Blunt Head Trauma.

Occipital condyle fractures (OCFs) have been treated as rare traumatic injuries, but the number of reported OCFs has gradually increased because of the popularization of computed tomography (CT) and magnetic resonance imaging (MRI). The patient in this report presented with OCFs and C1 dislocation, along with traumatic cerebellar hemorrhage, which led to craniovertebral junction instability. This case was also an extremely rare clinical condition in which the patient presented with traumatic lower cranial nerve palsy secondary to OCFs. When the patient was transferred to our hospital, the occipital bone remained defective extensively due to surgical treatment of cerebellar hemorrhage. For this reason, concurrent cranioplasty was performed with resin in order to fix the occipital bone plate strongly. The resin-made occipital bone was used to secure a titanium plate and screws enabled us to perform posterior fusion of the craniovertebral junction. Although the patient wore a halo vest for 3 months after surgery, lower cranial nerve symptoms, including not only neck pain but also paralysis of the throat and larynx, improved postoperatively. No complications were detected during outpatient follow-up, which continued for 5 years postoperatively.

Clinical Study on Cerebellar Contusion:A Report on 9 Cases and Literature Review

We report 9 cases of cerebellar contusion from April 2011 to September 2014 at our department. Frequency, clinicoradiological findings, mechanism of injury, treatments, and outcomes were retrospectively analyzed. Of 239 head injury cases admitted to our department during the same period, 9(3.8%)were diagnosed as cerebellar contusion. Among these 9 cases, 7 were men, and 2 were women. The patient age ranged from 12 to 83 years with a mean age of 64.7 years. The mechanism of injury was traffic accident in one patient, and fall in 8. All cases were associated with direct head trauma to the occiput, and radiographic studies showed occipital bone fracture in 8 cases. Six cases were managed conservatively. Three cases underwent suboccipital craniectomies and clot evacuations. Glasgow Outcome Scale(GOS)score at discharge were Good Recovery(GR)in 2, Moderate Disability(MD)in 2, Severe Disability(SD)in 3, Vegetative State(VS)in 1, and Dead(D)in 1. GOS scores in surgically treated cases were GR in 1, SD in 1, and VS in 1. Supratentorial severe traumatic lesions were concomitant with poor prognosis. Coup injury was a significant cause of cerebellar contusion. External decompression and clot evacuation were useful in patients who suffered severe cerebellar contusion;however, concomitant supratentorial lesions influenced the prognosis.

Factors affecting the surgical outcome of patients with cerebral contusions

Background: Study of factors influencing mortality after cerebral contusion is useful for clinicians to predict outcome of such patients. Hence present study was undertaken with the objective to analyse the factors affecting the surgical outcome of patients with cerebral contusions. Methods: This is a prospective study consisting of 187 cases of cerebral contusions operated in a period from August 2005 to Feb 2008, in the Department of Neurosurgery, Osmania General Hospital, Hyderabad. During the period of study total numbers of head injury admissions were 8163, out of which 964 cases were of cerebral contusions. Among them 187 cases underwent operation. All the patients underwent all necessary investigations. The data was analysed using proportions and appropriate statistical test wherever applicable. Results: Males were more than females but mortality rate was comparable. Most of the contusions were in 20 -40 years of age. Road traffic accidents were the commonest mode of injury. Most of the cases were moderate of server type of head injuries. The mortality rate in the severe head injury was 33%. Frontal and Temporal locations were the commonest site of contusion and the surgical outcome was better in frontal and temporal than parietal and cerebellar contusions. The overall mortality was 21%. It is seen that age more than 30 years, severe GCS and midline shift of more than 5 mm were the important predictors of mortality after surgery for cerebral contusions. Conclusions: Age more than 30 years; severe GCS and midline shift of more than 5 mm were the important predictors of mortality after surgery for cerebral contusions.

Craniocervical cerebellar contusion in a child with Chiari malformation.

Craniocervical cerebellar contusion in a child with Chiari malformation.

Traumatic basal subarachnoid hemorrhage suspected to have been caused by contrecoup cerebellar contusions: A case report

Traumatic cerebellar hemorrhagic contusions are infrequent, and the pathogenic mechanism involves a coup injury that is associated with motor vehicle accidents in most cases. Traumatic basal subarachnoid hemorrhage (TBSAH) is commonly reported after blunt trauma to the neck or unrestricted movement of the head, and the source of the hemorrhage is most frequently identified in the vertebrobasilar arteries. A 55-year-old woman who was addicted to alcohol was found dead in her bed. She had a bruise on the left side of her posterior parietal region, and autopsy revealed massive subarachnoid hemorrhage at the base of the brain; the hematoma was strongly attached to the right lower surface of the cerebellar hemisphere. No ruptured cerebral aneurysms, arteriovenous malformations or vertebrobasilar artery leakage were detected. Hemorrhagic cerebellar contusions were regarded as the source of the TBSAH. This is the first report of TBSAH suspected to have been caused by contrecoup cerebellar contusions.

Magnetic resonance features of closed head trauma in two foals

SummaryTwo foals were admitted for neurological signs after trauma. Clinical and diagnostic investigations were performed that were suggestive of closed head trauma characterised by right parietal bone deviation (ping‐pong fracture), cerebral contusion, haematoma and cerebellar contusion. The histopathological findings were consistent with areas of abnormal signal found on magnetic resonance investigations.

Postoperative imaging of vestibular schwannomas

Symptomatic vestibular schwannomas can be treated with resection (translabyrinthine, retrosigmoid [suboccipital], or middle cranial fossa approaches) or stereotactic radiosurgery. When appropriate, auditory brainstem stimulators can also be implanted in patients with current or impending hearing loss due to bilateral vestibular schwannomas. Imaging plays a prominent role in determining management following these procedures. In this article, the expected postoperative imaging appearances are depicted. The radiological features of complications are also reviewed, including recurrent tumor, fat graft necrosis, CSF leakage, infection, hydrocephalus, cerebral infarction, venous sinus thrombosis, hemorrhage, and temporal lobe and cerebellar contusions.

Traumatic pseudoaneurysm of the superior cerebellar artery

A 31-year-old man admitted to our hospital as the victim of aggression with an indeterminate object. At initial evaluation, he presented Glasgow Coma Scale score of 11, left anisocoria, without penetrating injury in head. Before performing computerized tomography scan, the patient’s level of consciousness worsened (Glasgow Coma Scale score 7). Skull computerized tomography scanning showed traumatic subarachnoid hemorrhage and hydrocephalus, with important ventricular blood, and a small cerebellar contusion (Fig. 1). External ventricular drainage with intracranial pressure monitoring was established. Because of the large amount of cisternal bleeding, we decided to perform a cerebral angiogram, that showed a pseudoaneurysm of the left superior cerebellar artery (SCA; Fig. 2). We performed an endovascular occlusion of the pseudoaneurysm (Fig. 3) without complications. In early follow-up, the patient developed shunt-dependent hydrocephalus. After final placement of a shunt, he was discharged for rehabilitation with Glasgow Outcome Scale score being 3. Traumatic intracranial aneurysms are rare, comprising less than 1% of all intracranial aneurysms. Less than 10% involve the posterior circulation. Aneurysms arising from the SCA are rarer and only six cases had been reported.1 Histologically, they are false aneurysms that contain none of the normal arterial layers but are lined by fibroconnective tissue surrounding a hole in the arterial wall.2 Penetrating wounds were responsible for 40% of the traumatic aneurysms located in posterior circulation.3 In the absence of a fracture or penetrating wound, like in our patient, some traumatic aneurysms have been observed on arteries in relation to the edge of rigid meningeal structures.1 We believe that in our case, the head trauma produced a rotary movement of the brain within the skull, tearing an arterial branch of the SCA that passes through the perimesencephalic cistern. DISCLOSURE The authors declare no conflicts of interest.

A case of the cerebellar contusion associated with subclinical Type I Chiari malformation: Case Report

A case of the cerebellar contusion associated with subclinical Type I Chiari malformation: Case Report

Cerebellar contusions as a possible cause of traumatic basal subarachnoid hemorrhage: A case report

Traumatic basal subarachnoid hemorrhage (TBSAH) is infrequent but of forensic neuropathological importance because of its high mortality and complex causal mechanisms. The source of the hemorrhage is most frequently identified in the vertebro-basilar arteries but often cannot be identified in these arteries. We present a case of TBSAH possibly originating from hemorrhagic cerebellar contusions due to fist blows to the neck. A 35-year-old woman, who was punched on the right side of the neck, became unconscious about 20 min later and died. Autopsy demonstrated a massive subarachnoid hemorrhage at the base of the brain, with blood clots attached to the right lower surface of the cerebellum. No tear was detected in the vertebro-basilar vessels, but there were hemorrhagic cerebellar contusions beneath the blood clots as a possible source of TBSAH. The site of impact to the neck suggested the cerebellar contusions to be a coup injury due to hard blows.

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

We encountered a case of head trauma with very unusual delayed events. A 68-year-old woman was admitted to our hospital after receiving a direct impact to her occiput in a traffic accident. Head CT scans showed a thin acute epidural hematoma in the posterior fossa corresponding to a linear fracture, followed by late onset of contrecoup left frontal epidural hematoma and subsequent cerebellar contusion in the right cerebellar hemisphere. Fifteen days after the trauma, the patient developed mild motor weakness of right upper extremity. MRIs demonstrated an infarct in the territory of the left recurrent artery of Heubner. Although rare, atypical late events in patients with head trauma as reported here should be taken into consideration during subacute follow-up periods.

CT scans essential after posttraumatic loss of consciousness

The frequency of “talk and deteriorate” in the emergency department (ED), subsequent deterioration of patients with seemingly “mild” head injury at the time of presentation, is summarized. Among the 1,073 patients with minor head injury treated in the last 5 years, five patients (0.5%) deteriorated in the ED. All of the five patients had experienced transient loss of consciousness (LOC) before presentation. Deterioration had occurred during treatment of trivial associated injuries in four-fifths of the cases. Computed tomography (CT) scans revealed four acute epidural hematomas and one cerebellar contusion. Retrospectively, immediate brain CT shortly after their arrival may have revealed the presence of traumatic intracranial hematomas before deterioration. Although routine use of CT scans in patients with mild head injury has been controversial, the authors conclude that CT scans should be taken if patients have experienced transient LOC to prevent or reduce the occurrence of deteriolation in ED. (Am J Emerg Med 2000;18:810-811.

Cerebellar contusion associated with Type I Chiari malformation following supratentorial head trauma: Case report

Acute presentation of Type I Chiari malformation in children is distinctly rare. An 11 year old male suffered a trauma to the right temporal-parietal region in a tobogganing accident resulting in an open depressed skull fracture. Radiographic evaluation included a Computed Tomographic scan which also demonstrated a significant cerebellar contusion and the presence of subarachnoid hemorrhage in the region of craniovertebral junction. Magnetic Resonance imaging revealed an underlying Type I Chiari malformation. Somatosensory evoked responses shortly following the injury demonstrated slowing of conduction across the lower brainstem. The open depressed fracture was debrided and elevated. Subsequent observation resulted in slow improvement in neurological function. A followup somatosensory evoked potential study performed 21 days following the accident showed improvement in conduction across the craniovertebral junction. The tonsillar ectopia associated with Type I Chiari malformation may predispose to cerebellar, upper spinal arid brainstem injury following supratentorial trauma. [Neural Res 1998; 20: 93–96]

Delayed Traumatic Intracerebellar Hematoma: Correlation Between the Location of the Hematoma and the Pre-existing Cerebellar Contusion

A rare case of delayed traumatic intracerebellar hematoma (DTIC1H) in a 54-year-old male achieved an excellent outcome without surgery. Analysis of this case and other reported cases suggests that DTIC1H occurs in two types: Group I with hematoma developing in previously contused areas, and Group II with hematoma developing in areas appearing normal on the initial computed tomographic scan. Group I hematomas occurred in the cerebellar cortex, but Group II hematomas occurred in the subcortical region or vermis where direct impact is less likely to have an effect. This suggests different mechanisms of development for DTIC1H.

Diagnosis and surgical treatment of disabling positional vertigo.

This report reviews the characteristic symptoms of disabling positional vertigo (DPV), and the tests used to reach a differential diagnosis of this disorder. Twenty-one patients were operated on consecutively for management of DPV between March, 1983, and September, 1984. In all patients one or more arteries or veins was found to be compressing the eighth cranial nerve when the nerve was exposed for microvascular decompression to relieve the symptoms of DPV. After the operation, 16 of the 21 patients were free of symptoms, or symptoms were so much improved that the patients returned to normal work or social life. Two patients had no improvement and three had limited relief of symptoms postoperatively. None of the patients experienced hearing loss as a result of the operation to relieve DPV, but one patient suffered a cerebellar contusion during the operation.

Complications accompanying occipital skull fracture.

One hundred thirty-four cases of occipital skull fracture seen over the past 15 years at the Medical Center Hospital of Vermont have been analyzed with respect to their clinical course and neurologic outcome. Among the cases reviewed, one third of patients had an uncomplicated course, 24% recovered with mild neurologic findings (such as cranial nerve palsy), and 13% died as a result of neurologic insult. This high morbidity results from combinations of traumatic subarachnoid hemorrhage, coup and contrecoup brain lesions, and injury at the skull base. Posterior fossa hematoma, cerebellar contusion, parietal and occipital lobe injury, and cranial nerve injuries associated with this lesion are discussed in detail. CAT scanning is now part of our diagnostic routine in patients with occipital fracture in coma grades 1-5 (Grady scale).

Delayed traumatic intracerebellar hematoma

A case of delayed traumatic intracerebellar hematoma is presented in which the patient survived after diagnosis and surgical intervention. The computed tomographic and clinical features of this entity are reported, and theories of pathogenesis are discussed. We advise a high index of suspicion for delayed intracerebellar hematomas in patients with cerebellar contusion following trauma.