Hematoma Of Posterior Fossa Research Articles

Spontaneous hematomas of the posterior cerebral fossa: about 5 cases

Spontaneous posterior fossa hematoma is defined as an intra-parenchymal hemorrhage that occurs suddenly following a spontaneous rupture of an artery or an arteriole. The objective of this work is to evaluate the prognosis of this pathology in our context compared to the data in the literature. Method and results: Our work is a retrospective study of 05 cases collected over a period of 4 years. The symptomatology for which the patients consulted varied: intracranial hypertension syndrome, neurological deficit. The positive diagnosis is made by cerebral CT scan and in view of the suspicion of a ruptured arteriovenous malformation, we recommended an arteriography in all patients but it was only performed in 2 patients. The surgical or abstentionist management was much discussed on a case-by-case basis. The outcome was favorable in 2 patients, 1 of whom had some neurological disorders. The study of data from the literature show that among the risk factors we find age, state of consciousness, the volume of the hematoma, ventricular flooding and whatever the therapeutic decision the extremely serious forms are always lethal.
 Keywords: hematoma, posterior cerebral fossa arteriovenous malformation, surgery

Non-traumatic epidural posterior fossa hematomas in child with Sensenbrenner syndrome: a case report and literature review

Background: Posterior fossa extradural hematomas are an uncommon condition with more than half of cases appearing in the pediatric population. Although the majority of cases are caused by substantial trauma, it may also be related to systemic diseases and bleeding disorders without the history of head trauma. Case report: We present the case of a 6-year-old female affected by Sensenbrenner syndrome with a non-traumatic subacute posterior fossa epidural hematoma. The patient was surgically treated and medically discharged without further neurological alteration. This is the first report of spontaneous cerebral hematoma associated with this syndrome in the literature. A literature review of the main aspects of both topics was performed. Conclusions: Although spontaneous posterior fossa epidural hematomas are rare, clinicians should be aware and highly suspicious of this differential diagnosis in certain situations such as coagulopathies and other specific systemic diseases, as fast recognition and assertive treatment are important for better outcomes.

Traumatic Cerebellar Hematoma: A Tertiary Care Experience of 23 Conservatively Managed Cases.

Context:Traumatic cerebellar hematomas are rare in comparison to nontraumatic cerebellar hematomas.Aims:The aim of this study is to evaluate the prognostic factors and outcome determining factors with regard to conservatively managed isolated traumatic cerebellar hematoma.Settings and Design:Retrospective cohort study.Materials and Methods:A retrospective study of 23 patients of conservatively managed isolated posterior fossa hematoma, admitted between August 2018 and May 2020, was conducted in the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi. Each of the patients was evaluated in terms of age, sex, mode of injury, clinical presentation, comorbidity, the severity of injury, best motor response, Glasgow Coma Scale (GCS) at admission, computed tomography findings, and Glasgow Outcome Scale at discharge/death.Statistical Analysis:Chi-square test and unpaired t-test were used. P < 0.05 was deemed statistically significant.Results:Mean volume of posterior fossa contusion was 8.9 ml. The cerebellar hemispheric (60.9%) location of hematoma was more common. Age at presentation (P = 0.0086), best motor response (P < 0.0001), severity of injury (P = 0.0002), GCS at admission (P < 0.0001), effacement of basal cistern (P < 0.0001), fourth ventricular compression and intraventricular hemorrhage (P = 0.0008), presence of hydrocephalus (P = 0.0142), subarachnoid hemorrhage (P = 0.0008), and volume of posterior fossa contusion (P = 0.0002) were significantly associated with outcome of posterior fossa contusion.Conclusion:Traumatic cerebellar hematoma is rare. Conservatively managed cerebellar hematoma patients must be monitored closely for neurological and radiological status. Patients who show deterioration in neurological or radiological status require surgical intervention.

Traumatic Posterior Fossa Hematoma, A Rare Entity: Study of 21 Cases.

Background Traumatic posterior fossa hematoma is a rare entity. Traumatic posterior fossa hematomas are associated with considerable morbidity and mortality and their surgical management remained controversial. Methods From August 2011 to August 2017, approximately 5,100 patients with head injury were managed. Authors reviewed clinical and radiological findings, management criteria, and outcome of posterior fossa hematoma in 21 patients. Results Out of 21 cases, 13 survived with our management. The Glasgow Coma Scale (GCS) on admission was higher in favorable group than in poor outcome group. Factors associated with Glasgow Outcome Scale in two groups were status of fourth ventricle, basal cisterns, subarachnoid hemorrhage (SAH), hematoma volume, and their location (hemispheric or midline). Similarly, associated supratentorial lesions, age, gender, lesions in other parts of body, and timing from injury to reporting to hospital were taken into consideration. Conclusion The factors correlated with patient outcome were age, sex, mode of injury, GCS at admission, associated intracranial hematomas, associated SAH, hematoma volume, hematoma location, basal cisterns, status of fourth ventricle, and associated multiple injuries on other body parts. It is hereby concluded that timely surgical intervention should be employed whenever indicated without delay. Posterior fossa hematomas were rarely observed in the pediatric age group.

Traumatic posterior fossa extradural hematoma

Background. Extradural hematoma of posterior fossa (PFEDH) is less common and there are not many articles about PFEDH. These patients can deteriorate very rapidly due to compression over brainstem. Thus, early identification and immediate intervention can save the lives of these patients.Objective. This study aims to conduct a comprehensive analysis of patients with PFEDH and evaluate the postoperative outcome which may be of help to make further preventive strategies.Methods and Materials. The study included 16 patients admitted with traumatic PFEDH from July 2016 to July 2018 at R.N.T. Medical College &amp; M.B. Groups of Hospital Udaipur, southwestern Rajasthan, India. We have retrospectively reviewed the data. Analysed factors were gender, age, Glasgow Coma Scale (GCS), Noncontrast CT scan findings, associated brain injury, type of intervention, Glasgow Outcome Scale (GOS). GOS was assessed at discharge, at 3 months and 6 months follow-up.Results. Out of a total of 16 patients, 11 were male and 5 were female with age ranging from 05-46 years. 12 patients had GCS 13 -15 at admission and only one of them had GCS &lt; 8. 15 patients underwent surgical intervention. At 6 months follow-up, 12 patients had good recovery GOS is 5.Conclusion. Early detection and immediate evacuation of PFEDHs should be done if causing fourth ventricle, basal cistern or brain stem compression. It may be rapidly fatal due to the expansion of hematoma leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early detection and immediate evacuation lead to a better outcome in these patients.

Conservative Plan for Post Traumatic Extradural Hematoma: Risk Factors Favouring Conversion to Surgery

Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative to a surgical management and identify the possible patient and disease related risk factors in such cases. Patients and Methods: This prospective study included 90 patients with traumatic EDH, admitted to the Neurotrauma department in Cairo University hospitals from March 2014 to August 2016. Their CT scans reveal EDH alone or with associated cerebral lesions initially fitting the criteria of conservative management. Results: The commonest site is frontal in 21 patients (23.3%), followed by parietotemporal in 18 patients (20%). While Posterior fossa hematomas occurred in 3 cases, which was the least common site (3.3%). The mean size of the EDH was 17.02 ml, with a standard deviation of 6.29 ml. The minimum size was 2 ml and a maximum of 28 ml. The cut off value of the size of the hematoma requiring conversion to a surgical management was 19 ml. Conclusion: Clear indications of EDH evacuation have been well known, however studying which risk factors are more liable to convert conservative management plan to evacuation is important. Increased caution and closer monitoring are required when the size of the hematoma is >19 ml or the hematoma is overlying a venous sinus. Unlike coagulopathy which was found to be a potential risk factor, but larger number study is needed.

Developing a pediatric neurosurgical training model.

OBJECTIVE One of the greatest challenges of pediatric neurosurgery training is balancing the training needs of the trainee against patient safety and parental expectation. The traditional "see one, do one, teach one" approach to training is no longer acceptable in pediatric neurosurgery. The authors have developed the baby Modeled Anatomical Replica for Training Young Neurosurgeons (babyMARTYN). The development of this new training model is described, its feasibility as a training tool is tested, and a new approach of integrating simulation into day-to-day training is suggested. METHODS In part 1 (development), a prototype skull was developed using novel model-making methods. In part 2 (validation), 18 trainee neurosurgeons (at various stages in training) performed the following 4 different procedures: 1) evacuation of a posterior fossa hematoma; 2) pterional craniotomy; 3) tapping of the fontanelle to obtain a CSF specimen; and 4) external ventricular drain insertion. Completion of the procedural stages (scored using a curriculum-based checklist) was used to test the feasibility of babyMARTYN as a training tool. Likert scale-based questionnaires were used to assess the model for face and content validity. Training benefit was assessed using pre- and posttraining ratings on the Physician Performance Diagnostic Inventory Scale (PPDIS). To determine the significance of improvement in median PPDIS score, the Wilcoxon matched-pairs signed-rank test was performed. RESULTS In part 1 (development), the model was successfully developed with good fidelity. In part 2 (validation), the validation data demonstrated feasibility, face, and content validity. The PPDIS score significantly increased for all groups after babyMARTYN training, thereby indicating a potential future role for babyMARTYN in the training of pediatric neurosurgeons. CONCLUSIONS This recent collaborative neurosurgical development by the Royal College of Surgeons of England is designed to supplement current neurosurgical training. High-fidelity, portable, operation-specific models enable preoperative planning and have the potential to be used in an operating room environment prior to novel operations. A "see one, simulate one, do one" approach for pediatric neurosurgical training using babyMARTYN is suggested.

Metods of diagnostic in the head-brain injury.

Background. Injuries are 3rd in the structure of the population mortality. Over the past 15 years, mortality from injury came on second place, ahead of cancer. Traumatic brain injury is the most common damage types and ranges from 36 to 40 % of all injuries. The incidence of posterior fossa hematomas among intracranial hematomas has been reported to be 2 to 3%. Objective. The aim of the present study was to investigate the features of posterior fossa hematoma, including posterior fossa epidural hematoma, posterior fossa subdural hematoma and intracerebellar hematoma. The aim of the study was to determine the clinical features and diagnosis of severe head injuries. Methods. Analyzed the medical records of patients admitted to the Department of Neurosurgery Regional Hospital. They can be: furrow branches of the middle meningeal artery; wedge-parietal sulcus sinus; Channels diploic veins; cleft wedge - occipital synchondrosis behind the backs of the pituitary fossa; occipital-mastoid suture. Results and conclusion. With the introduction of the practice of computer and magnetic resonance imaging to diagnose damage to structures in the presence of hematomas in the posterior fossa it became much easier. Since patients are not always in a conscious state data instrumental methods of diagnosis in a very short time allow the diagnosis and differential diagnosis in injuries that are accompanied by the presence of intracranial hematomas in the posterior fossa.

The natural history of AVM hemorrhage in the posterior fossa: comparison of hematoma volumes and neurological outcomes in patients with ruptured infra- and supratentorial AVMs.

Patients with posterior fossa arteriovenous malformations (AVMs) are more likely to present with hemorrhage than those with supratentorial AVMs. Observed patients subject to the AVM natural history should be informed of the individualized effects of AVM characteristics on the clinical course following a new, first-time hemorrhage. The authors hypothesize that the debilitating effects of first-time bleeding from an AVM in a previously intact patient with an unruptured AVM are more pronounced when AVMs are located in the posterior fossa. The University of California, San Francisco prospective registry of brain AVMs was searched for patients with a ruptured AVM who had a pre-hemorrhage modified Rankin Scale (mRS) score of 0 and a post-hemorrhage mRS score obtained within 2 days of the hemorrhagic event. A total of 154 patients met the inclusion criteria for this study. Immediate post-hemorrhage presentation mRS scores were dichotomized into nonsevere outcome (mRS ≤ 3) and severe outcome (mRS > 3). There were 77 patients in each group. Univariate and multivariate logistic regression analyses using severe outcome as the binary response were run. The authors also performed a logistic regression analysis to measure the effects of hematoma volume and AVM location on severe outcome. Posterior fossa location was a significant predictor of severe outcome (OR 2.60, 95% CI 1.20-5.67, p = 0.016) and the results were strengthened in a multivariate model (OR 4.96, 95% CI 1.73-14.17, p = 0.003). Eloquent location (OR 3.47, 95% CI 1.37-8.80, p = 0.009) and associated arterial aneurysms (OR 2.58, 95% CI 1.09, 6.10; p = 0.031) were also significant predictors of poor outcome. Hematoma volume for patients with a posterior fossa AVM was 10.1 ± 10.1 cm(3) compared with 25.6 ±28.0 cm(3) in supratentorial locations (p = 0.003). A logistic analysis (based on imputed hemorrhage volume values) found that posterior fossa location was a significant predictor of severe outcome (OR 8.03, 95% CI 1.20-53.77, p = 0.033) and logarithmic hematoma volume showed a positive, but not statistically significant, association in the model (p = 0.079). Patients with posterior fossa AVMs are more likely to have severe outcomes than those with supratentorial AVMs based on this natural history study. Age, sex, and ethnicity were not associated with an increased risk of severe outcome after AVM rupture, but posterior fossa location, associated aneurysms, and eloquent location were associated with poor post-hemorrhage mRS scores. Posterior fossa hematomas are poorly tolerated, with severe outcomes observed even with smaller hematoma volumes. These findings support an aggressive surgical posture with respect to posterior fossa AVMs, both before and after rupture.

Clinical comparative study on different surgical methods for treatment of cerebellar hemorrhage

Objective To discuss the clinical effect of different surgical methods for treatment of cerebellar hemorrhage.Methods 62 patients with spontaneous cerebellar hemorrhage were randomly divided into 2 groups with 31 cases in each group.Observation group was given posterior fossa hematoma evacuation,while control group was given cerebellar decompression.Clinical effect and postoperative complications of the 2 groups were compared.Results Clinical effective rate of observation group was obviously higher than that of control group (87.10％ vs 61.29％); 2 cases (6.45％) of intracranial infection and 1 case (3.23％) of incision infection occurred in observation group and no severe complications like leakage of cerebrospinal fluid,subcutaneous hydrops and false cyst were found in observation group (compared with control group,P ＜ 0.05).Conclusion Posterior fossa hematoma evacuation for treatment of spontaneous cerebellar hemorrhage has accurate clinical effect and few complications.Early surgical treatment can improve clinical effect and prognosis. Key words: Hematoma evacuation; Ventricular drainage; Cerebellar hemorrhage; Clinical analysis

The Management of Birth-Related Posterior Fossa Hematomas in Neonates

Symptomatic posterior fossa hematoma in the term newborn is rare. To report on the management and outcome of posterior fossa subdural hematoma (PFSDH) in neonates. A retrospective analysis of the department database and clinical notes of neonates admitted since 1985 with a PFSDH was performed together with a literature review of similar case series. Sixteen patients were included. The median gestational age was 40 weeks with a high proportion of primiparous mothers (n = 9) and forceps delivery (n = 9). Nine neonates had symptoms of brainstem dysfunction within the first 24 hours of life, whereas the other 7 had a delayed presentation (median 4 days) with signs of raised intracranial pressure due to hydrocephalus. Each patient had a cranial ultrasound followed by computed tomography scan that showed the PFSDH. Eleven neonates required surgical evacuation of the PFSDH, whereas hydrocephalus was managed by transient external ventricular drainage in 2 further patients. Eventually, 2 neonates required a permanent ventriculoperitoneal shunt. Five neonates had no operative intervention. With a mean follow-up of 7.8 years, 2 patients had mild developmental delay and 1 had severe developmental delay. The 13 other patients had a normal development. In neonates with a PFSDH, surgery can be safely performed in those who have clinical and radiological signs of brainstem compression or hydrocephalus. A small number of neonates require a ventriculoperitoneal shunt in the long term. Initial aggressive resuscitation should be performed even in cases of initial severe brainstem dysfunction because of the good long-term neurological outcome.

Embolic pulmonary complication of a cerebral arteriovenous malformation treatment

A 34-year-old man was admitted in the emergency room with headache, vomiting, gait ataxia, dizziness and vertigo. He was submitted to a cranial CT that showed an important hydrocephalus secondary to a forth ventricle compression by a posterior fossa hematoma. He received advanced life support in an intensive care unit (ICU) and was submitted to an external ventricular drainage (EVD), posteriorly converted to ventriculoperitoneal shunt (VPS) (visualized in the right hemithorax). After stabilization a magnetic resonance image (MRI) and an arteriography revealed a large cerebellum arteriovenous malformation (AVM).

Craniocerebral Trauma Inflicted by Television Falls*

Accidents and inflicted trauma account for 33% and 5-8% of childhood deaths, respectively. Injuries secondary to falling televisions have been reported in the clinical literature. However, descriptions of such injuries at autopsy are limited. The severity and patterns of injury may mimic those considered ''typical'' of inflicted trauma. Thus, integration of data from clinical, scene investigation, and autopsy is necessary for determination of the cause and manner of death. We present autopsy findings from two cases which illustrate injuries sustained from falling televisions. Findings common to both cases include subscalpular hemorrhages, skull fractures, subdural hemorrhages, brain injuries, and optic nerve sheath hemorrhages. The first case showed postsurgical changes secondary to evacuation of a posterior fossa hematoma; three-dimensional reconstruction of the admission computed tomography scan demonstrated the extent of the preintervention skull fractures. In addition, the second case showed a right epidural hematoma. Only case two showed retinal hemorrhage.

The Acute Management of Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is a devastating disease with high rates of mortality and morbidity. The major risk factors for ICH include chronic arterial hypertension and oral anticoagulation. After the initial hemorrhage, hematoma expansion and perihematoma edema result in secondary brain damage and worsened outcome. A rapid onset of focal neurological deficit with clinical signs of increased intracranial pressure is strongly suggestive of a diagnosis of ICH, although cranial imaging is required to differentiate it from ischemic stroke. ICH is a medical emergency and initial management should focus on urgent stabilization of cardiorespiratory variables and treatment of intracranial complications. More than 90% of patients present with acute hypertension, and there is some evidence that acute arterial blood pressure reduction is safe and associated with slowed hematoma growth and reduced risk of early neurological deterioration. However, early optimism that outcome might be improved by the early administration of recombinant factor VIIa (rFVIIa) has not been substantiated by a large phase III study. ICH is the most feared complication of warfarin anticoagulation, and the need to arrest intracranial bleeding outweighs all other considerations. Treatment options for warfarin reversal include vitamin K, fresh frozen plasma, prothrombin complex concentrates, and rFVIIa. There is no evidence to guide the specific management of antiplatelet therapy-related ICH. With the exceptions of placement of a ventricular drain in patients with hydrocephalus and evacuation of a large posterior fossa hematoma, the timing and nature of other neurosurgical interventions is also controversial. There is substantial evidence that management of patients with ICH in a specialist neurointensive care unit, where treatment is directed toward monitoring and managing cardiorespiratory variables and intracranial pressure, is associated with improved outcomes. Attention must be given to fluid and glycemic management, minimizing the risk of ventilator-acquired pneumonia, fever control, provision of enteral nutrition, and thromboembolic prophylaxis. There is an increasing awareness that aggressive management in the acute phase can translate into improved outcomes after ICH.

Acute Epidural Hematoma in a Patient With Glanzmann's Thrombasthenia -Case Report-

A 7-year-old girl with Glanzmann's thrombasthenia (GT) fell and hit her head against a table. Within 2 hours she began to vomit and became drowsy. On admission to our hospital her Glasgow Coma Scale score was 13. Computed tomography (CT) on admission showed acute epidural hematoma in the left posterior fossa. We administered platelets, performed emergent lateral suboccipital craniotomy, and totally removed the epidural hematoma. Postoperative CT showed no evidence of hematoma or re-bleeding. She was discharged without neurological deficits 14 days after the operation. GT is a platelet aggregation disorder due to a functional loss of platelet membrane glycoprotein IIb/IIIa. The present patient with GT underwent successful emergency craniotomy after platelet transfusion.

The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of haematomas

The correlation between hematoma volume and outcome in ruptured arteriovenous malformations (AVM) with accompanying posterior fossa hematoma was retrospectively evaluated. Microsurgery operations were performed on 127 patients with intracranial AVM between January 1998 and January 2009 at our clinic. Fifteen (11.8%) patients were identified as suffering from posterior fossa AVM, and twelve of these patients presented with a cerebellar hematoma. All patients were clinically evaluated according to the following criteria: modified Rankin Scale (mRS) prior to surgery, Spetzler-Martin grade (SMG) of the AVMs, hematoma volume prior to surgery, and mRS following surgery. Postoperative mRS scores were significantly lower than preoperative scores (p=0.0001). Postoperative outcomes were concordant with the SMG of the AVMs (r=0.67, p=0.033), hematoma volume (r=0.537, p=0.072) and preoperative mRS scores (r=0.764, p=0.004). These analyses show that the postoperative mRS score is strongly correlated with a preoperative mRS score, hematoma volume and SMG. Posterior fossa AVMs present an increased risk for hemorrhage and for increased morbidity and mortality. Cases with hematoma should be operated on an urgent basis. We conclude that hematoma volume is a factor that impacts postoperative results and prognosis. SMG and preoperative mRS scores were also correlated with outcome.

Traumatic Acute Subdural Hematoma Extending from the Posterior Cranial Fossa to the Cerebellopontine Angle

Posterior cranial fossa subdural hematomas and extension of the subdural hematoma to the cerebellopontine angle is rarely seen and the concurrent development of acute peripheral facial palsy and the management strategy have not previously been reported in this pathology because of its rarity. We present this case to emphasize that minor head trauma may lead to a posterior cranial fossa hematoma extending to the cerebellopontine angle and cause peripheral facial palsy in patients using aspirin (acetylsalicylic acid). In addition, partial evacuation and waiting for the resorption of the hematoma may help to prevent damage to the 7th and 8th cranial nerves.

Traumatic subacute subdural effusion in the posterior fossa associated with secondary acute hydrocephalus in a neonate

The authors report on a neonatal patient with traumatic subacute subdural effusion in the posterior fossa associated with secondary acute hydrocephalus. The infant fell from his mother's hand onto the floor, injuring his left parietal region. Computed tomography (CT) scans of the patient's head revealed a linear fracture of the left parietal bone, a small contusion in the right temporal lobe, and a small subdural hematoma in the right posterior fossa with thin subdural effusion. Serial CT scans revealed a progressive increase in subdural effusion bilaterally in the posterior fossa. On Day 7 the anterior fontanelle was tense and CT scans revealed marked hydrocephalus associated with thick subdural effusion in the posterior fossa. External drainage of both the subdural effusion and dilated lateral ventricles improved the patient's condition, and no reaccumulation of subdural effusion has been observed. The origin and treatment of this rare clinical entity is discussed.

Anatomical cerebellar protection of contrecoup hematoma development. Analysis of the mechanism of 30 posterior fossa coup hematomas.

The aim of this paper is to present the topographical/anatomical conditions that protect the posterior fossa from posterior fossa hematoma (PFH) resulting from contrecoup mechanisms and to point out the value of neuroradiological findings in determining force direction and transition. The biomechanism of this clinical entity also plays an important role in correct forensic interpretation. Generally, PFH are rare. In our series, they occurred exclusively as a result of forces applied to the occipital region. However, their appearance as a result of contrecoup mechanisms is exceptional. Considering the particular anatomical traits that protect the posterior fossa from the force transition of fronto-occipital (F-O) direction we put forth seven hypotheses which should explain the low incidence of PFH. Between 1989 and 1998, we treated 523 patients with intracranial hematomas caused by blunt trauma. Among them were 30 patients with PFH. All of them sustained an occipital bone fracture, confirming the coup lesion. In conclusion, it is difficult to determine clinically whether forces in the F-O direction could produce PFH as a result of contrecoup mechanism. That could be only proven in vivo by neuroradiological findings.

Hematomas bulbares puros

Purely bulbar hematomas are not common (0.25%-0.50% of all intraparenchymatous hematomas), probably because of the particular characteristics of the anatomy and hemodynamics of the bulbar circulation. We selected 18 cases. Three of these were our own and the purely bulbar localization was confirmed by neuroimaging surgical findings and necropsy. Its appearance was related to arterial hypertension, anticoagulant treatment and obvious or occult vascular malformations, although in a considerable proportion (39%) no cause was found. Although arterial hypertension is less important in its etiopathogenesis as compared with other sites of intraparenchymatous hemorrhage, 7 of the patients were hypertensive. The commonest clinical findings were nystagmus (72%), and dysphagia and hypoglossal paralysis (61%). The commonest site was posterior. Arteriography was of little use since this was normal in all the cases in which it was done (72%). The presence of angiographically occult malformations made it advisable to use magnetic resonance and repeat this after the acute phase. Three quarters of the patients were treated medically. Mortality (22%) was lower than the overall rate for posterior fossa hematomas, and the prognosis was better since no survivors had incapacitating sequelae. The specific etiopathogeneses, clinical characteristics and course of bulbar hematomas makes it advisable to do a differential study regarding other types of intracerebral hemorrhage.