Cerebellar Hemorrhage Research Articles

Cerebellar Hemorrhage Revealing a Community Acquired Bacterial Meningitis: A Rare Complication

Hemorrhagic stroke can be an exceptional complication of meningitis and constitute a differential diagnosis in our observation. A 73-year-old man, with a history of arterial hypertension, chronic smoking for 25 years, and has been abstinent for 30 years. The patient had had a fever of 38 °C for one week before admission with vomiting, headache complicated by altered consciousness, with suspension of contact. The patient had a Glascow Coma Scale at 10, and normal hemodynamic and respiratory parameters. CT scan was objective a cerebellar hematoma in the vermis without a compression signs. Lambar punction had objective a shady cerebrospinl fluid, with 234 white elements and Streptococcus B in the gram coloration.

Increased Intracranial Hemorrhage Amid Elevated Inflammatory Markers in Those With COVID-19 Supported With Extracorporeal Membrane Oxygenation.

COVID-19-related coagulopathy is a known complication of SARS-CoV-2 infection and can lead to intracranial hemorrhage (ICH), one of the most feared complications of extracorporeal membrane oxygenation (ECMO). We sought to evaluate the incidence and etiology of ICH in patients with COVID-19 requiring ECMO. Patients at two academic medical centers with COVID-19 who required venovenous-ECMO support for acute respiratory distress syndrome (ARDS) were evaluated retrospectively. During the study period, 33 patients required ECMO support; 16 (48.5%) were discharged alive, 13 died (39.4%), and 4 (12.1%) had ongoing care. Eleven patients had ICH (33.3%). All ICH events occurred in patients who received intravenous anticoagulation. The ICH group had higher C-reactive protein (P = 0.04), procalcitonin levels (P = 0.02), and IL-6 levels (P = 0.05), lower blood pH before and after ECMO (P < 0.01), and higher activated partial thromboplastin times throughout the hospital stay (P < 0.0001). ICH-free survival was lower in COVID-19 patients than in patients on ECMO for ARDS caused by other viruses (49% vs. 79%, P = 0.02). In conclusion, patients with COVID-19 can be successfully bridged to recovery using ECMO but may suffer higher rates of ICH compared to those with other viral respiratory infections.

Intracranial Hemorrhage in COVID-19 Patients

ObjectiveTo describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients. MethodsRetrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging, and outcome data were analyzed. ICH rates among all strokes were compared to the same time period in 2019 in two-week time intervals. Correlation of systolic blood pressure variability (SBPV) and neutrophil-to-lymphocyte ratio (NLR) to clinical outcomes were performed. ResultsOf 324 patients who presented with stroke, 65 (20%) were diagnosed with non-traumatic ICH: 8 had confirmed and 3 had highly suspected COVID-19. Nine (82%) had at least one associated risk factor for ICH. Three ICHs occurred during inpatient anticoagulation. More than half (6) suffered either deep or cerebellar hemorrhages; only 2 were lobar hemorrhages. Two of 8 patients with severe pneumonia survived. During the NYC COVID-19 peak period in April, ICH comprised the highest percentage of all strokes (40%), and then steadily decreased week-after-week (p = 0.02). SBPV and NLR were moderately and weakly positively correlated to discharge modified Rankin Scale, respectively. ConclusionsCOVID-19 associated ICH is often associated with at least one known ICH risk factor and severe pneumonia. There was a suggestive relative surge in ICH among all stroke types during the first peak of the NYC pandemic. It is important to be vigilant of ICH as a possible and important manifestation of COVID-19.

Factors Impacting Hydrocephalus Incidence in Intracerebral Hemorrhage: A Retrospective Analysis

To test which intracerebral hemorrhage (ICH) characteristics impact incidence of hydrocephalus and characterize subsequent impact on outcomes. A search of the electronic medical record of Sinai Grace Hospital between January 2009 and April 2018 using International Classification of Diseases, Ninth Revision and Tenth Revision codes for ICH identified 847 patients. After excluding patients with hemorrhagic conversion of stroke, subarachnoid hemorrhage, and traumatic hemorrhage, 560 patients remained for analysis. Generalized linear modeling was used to assess variance in modified Rankin Scale (mRS) score and length of stay. Incidence of hydrocephalus on arrival varied with ICH volume (P < 0.001), intraventricular hemorrhage (IVH) status (P < 0.001), bleed location (P < 0.001), and external ventricular drain (EVD) status (P < 0.001). An EVD was inserted in 47% of patients presenting with IVH (n= 102/217), while 4% of patients without IVH received an EVD (n= 14/343) (P < 0.001). Hemorrhage locations had different rates of EVD placement: thalamic 43%, basal ganglia 22%, cerebellar 28%, brainstem 21%, lobar 7% (P < 0.001). Shunt dependency did not vary between bleed locations (P= 0.072). Variance in mRS score was explained by IVH, bleed location, hydrocephalus on arrival, and ICH volumes. In particular, cerebellar hemorrhage location was associated with better outcomes (mean discharge mRS score of 3.3 vs. 3.9, P < 0.001). Bleed characteristics affect incidence of hydrocephalus on admission, rates of long-term shunt dependency, and outcomes. Hemorrhage location did not predict shunt dependency; however, it did predict outcomes. Specifically, cerebellar ICH was associated with a better discharge mRS score.

Transcondylar fossa approach for the large, high-flow, and diffuse arteriovenous malformation of the posterior fossa

Posterior fossa high-grade arteriovenous malformations (AVMs) are challenging diseases. This video presents the treatment of a patient with a diffuse, high-flow AVM of the posterior fossa on the tonsil and cerebellopontine angle (4 cm in diameter) and deep draining veins. The patient had an intraventricular and cerebellar hemorrhage. After conservative treatment, total resection of the AVM was performed with embolization and surgery. The authors resected the nidus after the endovascular embolization, on the same day. The postoperative course was uneventful, and the patient was discharged with almost full recovery.The video can be found here: https://youtu.be/logCCn3uKUc

Analysis of Responses of a Healthy Subject and Subjects with Cerebellar Hemorrhage and Parkinson's Disease in Eye–Hand Coordination Pointing with Pencil Test

Analysis of Responses of a Healthy Subject and Subjects with Cerebellar Hemorrhage and Parkinson's Disease in Eye–Hand Coordination Pointing with Pencil Test

Remote cerebellar hemorrhage after microsurgical treatment of anterior circulation aneurysms: a single centre 8-year experience

Remote cerebellar hemorrhage after microsurgical treatment of anterior circulation aneurysms: a single centre 8-year experience

A case of cerebellar hemorrhage complicated with takotsubo cardiomyopathy: a case report and literature review

A case of cerebellar hemorrhage complicated with takotsubo cardiomyopathy: a case report and literature review

Incidence of brain lesions in moderate-late preterm infants assessed by cranial ultrasound and MRI: The BIMP-study

PurposeTo evaluate the incidence and characteristics of brain lesions in moderate-late preterm (MLPT) infants, born at 32–36 weeks’ gestation using cranial ultrasound (cUS) and magnetic resonance imaging (MRI). MethodsProspective cohort study carried out at Isala Women and Children’s Hospital between August 2017 and November 2019. cUS was performed at postnatal day 3–4 (early-cUS), before discharge and repeated at term equivalent age (TEA) in MLPT infants born between 32+0 and 35+6 weeks’ gestation. At TEA, MRI was also performed. Several brain lesions were assessed e.g. hemorrhages, white matter and deep gray matter injury. Brain maturation was visually evaluated. Lesions were classified as mild or moderate-severe. Incidences and confidence intervals were calculated. Results166 MLPT infants were included of whom 127 underwent MRI. One or more mild lesions were present in 119/166 (71.7 %) and moderate-severe lesions in 6/166 (3.6 %) infants on cUS and/or MRI. The most frequent lesions were signs suggestive of white matter injury: inhomogeneous echogenicity in 50/164 infants (30.5 %) at early-cUS, in 12/148 infants (8.1 %) at TEA-cUS and diffuse white matter signal changes (MRI) in 27/127 (23.5 %) infants. Cerebellar hemorrhage (MRI) was observed in 16/127 infants (12.6 %). Delayed maturation (MRI) was seen in 17/117 (13.4 %) infants. Small hemorrhages and punctate white matter lesions were more frequently detected on MRI than on cUS. ConclusionsIn MLPT infants mild brain lesions were frequently encountered, especially signs suggestive of white matter injury and small hemorrhages. Moderate-severe lesions were less frequently seen.

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.

The Role of Altered CSF Dynamics in Remote Cerebellar Hemorrhage

Wu, Esther BA; Anderson, Matthew MD; Thompson, Bradford; Klinge, Petra M MD Author Information

Comparative performance of head ultrasound and MRI in detecting preterm brain injury and predicting outcomes: A systematic review.

To systematically review the literature to compare the performance of head ultrasound (HUS) and magnetic resonance imaging (MRI) in their ability to detect brain injury and their predictive value for neurodevelopmental outcomes. This was a systematic review based on literature search in three electronic databases (MEDLINE, EMBASE, Cochrane Library) and additional sources for studies on routine brain injury screening in preterm neonates published during 2000-May 2020. Studies were included if they reported on the comparative performance of HUS and MRI in detecting preterm brain injury and/or their predictive value for neurodevelopmental outcomes. Findings from the included studies underwent narrative synthesis. Forty-six studies were included. In comparison with HUS, MRI detected more anomalies and provided more details on the severity and the extent of preterm brain injury, particularly for white matter injury and cerebellar haemorrhage. Neonatal neuroimaging predicted outcomes with high negative predictive value but relatively low positive predictive value. The prognostic value of neonatal neuroimaging varied according to several factors including modality and timing of imaging, and tools used for grading brain injury. Compared with HUS, MRI offers a better characterisation of preterm brain injury and may enhance the ability to predict neurodevelopmental outcomes.

Chapter 13 - Hemorrhagic stroke

Hemorrhagic stroke comprises about 20% of all strokes, with intracerebral hemorrhage (ICH) being the most common type. Frequency of ICH is increased where hypertension is untreated. ICH in particularly has a disproportionately high risk of early mortality and long-term disability. Until recently, there has been a paucity of randomized controlled trials (RCTs) to provide evidence for the efficacy of various commonly considered interventions in ICH, including acute blood pressure management, coagulopathy reversal, and surgical hematoma evacuation. Evidence-based guidelines do exist for ICH and these form the basis for a framework of care. Current approaches emphasize control of extremely high blood pressure in the acute phase, rapid reversal of vitamin K antagonists, and surgical evacuation of cerebellar hemorrhage. Lingering questions, many of which are the topic of ongoing clinical research, include optimizing individual blood pressure targets, reversal strategies for newer anticoagulant medications, and the role of minimally invasive surgery. Risk stratification models exist, which derive from findings on clinical exam and neuroimaging, but care should be taken to avoid a self-fulfilling prophecy of poor outcome from limiting treatment due to a presumed poor prognosis. Cerebral venous thrombosis is an additional subtype of hemorrhagic stroke that has a unique set of causes, natural history, and treatment and is discussed as well.

Remote Cerebellar Hemorrhage after Removal of Large Convexity Meningioma

&#x0D; &#x0D; &#x0D; Remote cerebellar hemorrhage is a rare postoperative complication. It can occur after infratentorial or supratentorial craniotomies, later being more common. Remote cerebellar hemorrhage is considered to be a self-limited and benign condition. The exact pathophysiology of remote cerebellar hemorrhage remains unclear, but reports have suggested an association with excessive loss of cerebrospinal fluid.&#x0D; We report a case of remote cerebellar hemorrhage after supratentorial craniotomy for large convexity meningioma without excessive loss of cerebrospinal fluid.&#x0D; &#x0D; &#x0D;

Location and Size of Preterm Cerebellar Hemorrhage and Childhood Development

To examine the association between cerebellar hemorrhage (CBH) size and location and preschool-age neurodevelopment in very preterm neonates. Preterm magnetic resonance images of 221 very preterm neonates (median gestational age = 27.9 weeks) were manually segmented for CBH quantification and location. Neurodevelopmental assessments at chronological age 4.5 years included motor (Movement Assessment Battery for Children, 2nd Edition [MABC-2]), visuomotor integration (Beery-Buktenica Developmental Test of Visual-Motor Integration, 6th Edition), cognitive (Wechsler Primary and Preschool Scale of Intelligence, 3rd Edition), and behavioral (Child Behavior Checklist) outcomes. Multivariable linear regression models examined the association between CBH size and 4.5-year outcomes accounting for sex, gestational age, and supratentorial injury. Probabilistic maps assessed CBH location and likelihood of a lesion to predict adverse outcome. Thirty-six neonates had CBH: 14 (6%) with only punctate CBH and 22 (10%) with ≥1 larger CBH. CBH occurred mostly in the inferior aspect of the posterior lobes. CBH total volume was independently associated with MABC-2 motor scores at 4.5 years (β = -0.095, 95% confidence interval = -0.184 to -0.005), with a standardized β coefficient (-0.16) that was similar to that of white matter injury volume (standardized β = -0.22). CBH size was similarly associated with visuomotor integration and externalizing behavior but not cognition. Voxelwise odds ratio and lesion-symptom maps demonstrated that CBH extending more deeply into the cerebellum predicted adverse motor, visuomotor, and behavioral outcomes. CBH size and location on preterm magnetic resonance imaging were associated with reduced preschool motor and visuomotor function and more externalizing behavior independent of supratentorial brain injury in a dose-dependent fashion. The volumetric quantification and localization of CBH, even when punctate, may allow opportunity to improve motor and behavioral outcomes by providing targeted intervention. ANN NEUROL 2020;88:1095-1108.

Hemorragia cerebelosa por trombocitopenia inmune

La trombocitopenia inmune primaria (PTI) es un desorden que tiene como caracteristica el aumento de la destruccion de las plaquetas o disminucion en su produccion resultando niveles bajos de las mismos y un riesgo aumentado de sangrado. Se presenta el caso de un paciente de sexo masculino, de 27 anos de edad, previamente sano, que acude a consulta por cuadro de 48 hs de evolucion de aparicion de petequias. Durante su evolucion presenta hemorragia cerebelosa con hipertension endocraneana aguda que lo lleva al obito a pesar del tratamiento.

The efficacy of routine brain MRI for term neonates admitted to neonatal intensive care unit

Objective The efficacy of routine brain MRI for term infants admitted to a neonatal intensive care unit (NICU) has not been well studied. This study aimed to investigate the types and frequencies of abnormal findings on routine brain MRI and the predictors of abnormality for term infants in an NICU setting. Methods We examined the results of routine brain MRI of 239 term infants who were hospitalized in the NICU. Data on the perinatal factors were also collected, and the association with MRI abnormalities was assessed. Results Of the 239 MRI scans, we found abnormal findings in 52 (21.8%) patients. Intracranial hemorrhage accounted for 74% of the abnormal findings, including subdural, intraparenchymal, cerebellar, and subependymal hemorrhages. Twenty-six percent of these were ischemic lesions, including cerebral infarction, white matter abnormal intensities, and cystic periventricular leukomalacia (PVL). Five (2.1%) MRI scans required detailed examination or were known to be associated with a poor neurological prognosis. No patient needed treatment for the findings. An Apgar score ≤7 points at 5 min was identified as a perinatal factor significantly associated with abnormal MRI findings (adjusted OR = 3.034, 95% CI: 1.107–8.315, p = .031). Conclusion The efficacy of routine brain MRI for term infants admitted to the NICU was limited. Routine brain MRI is not recommended for this population.

Neuronophagia and microglial nodules in a SARS-CoV-2 patient with cerebellar hemorrhage

We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency department. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection.

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