Cerebellar haemorrhage is a form of intracranial haemorrhage and is most frequently seen in the setting of poorly controlled hypertension, although this can of course also be secondary to an underlying lesion (e.g. tumour or vascular malformation) or due to supratentorial surgery (see remote cerebellar haemorrhage).
This article concerns itself with primary cerebellar haemorrhages.
The demographics of affected patients reflect those of patients with long term poorly controlled hypertension, and as such patients are usually elderly.
Cerebellar haemorrhages only account for approximately 10% of all intracerebral haemorrhages 3.
Clinical presentation depends on the size and speed of enlargement of the haemorrhage. Unlike pontine haemorrhages which are usually obvious to both the clinician and the patient, cerebellar haemorrhages, if small enough, can present relatively subtly. Cerebellar signs (e.g. ataxia, nystagmus) 1. Larger bleeds can impair consciousness and obstruct the fourth ventricle resulting in obstructive hydrocephalus.
As with other haemorrhagic strokes, CT is usually the first, and often the only imaging investigation obtained.
As with other acute haemorrhages, cerebellar haemorrhages appear as regions of hyperdensity within the cerebellar hemispheres. Extension into the fourth ventricle or subarachnoid space is relatively common.
Treatment and prognosis
Prompt diagnosis and neurosurgical referral are therefore key. Typically if a haemorrhage causes brainstem compression or is greater than 3cm in diameter (20-30mL) evacuation is beneficial 2.
Stroke and intracranial haemorrhage
stroke and intracranial haemorrhage
- general discussions
- scoring and classification systems
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- internal capsule infarct
- ataxic hemiparesis syndrome: MCA perforators or basilar artery perforators
- lacunar infarct
- thalamic infarct
- cerebellar infarct
- midbrain infarct
- pontine infarct
- medullary infarct
- acute spinal cord ischaemia syndrome
- hemispheric infarcts
- by vascular territory
- anterior cerebral artery infarct
- anterior choroidal artery infarct
- anterior inferior cerebellar artery infarct
- basilar artery infarct
- middle cerebral artery infarct
- posterior cerebral artery infarct
- posterior inferior cerebellar artery infarct
- superior cerebellar artery infarct
- basal ganglia haemorrhage
- cerebellar haemorrhage
- cerebral contusions
- CTA spot sign
- haemorrhagic venous infarct
- haemorrhagic transformation of an ischaemic infarct
- hypertensive intracranial haemorrhage
- intraventricular haemorrhage (IVH)
- lobar haemorrhage
- pontine haemorrhage
- remote cerebellar haemorrhage
- extra-axial haemorrhage
- extradural haemorrhage (EDH)
- intralaminar dural haemorrhage
- subdural haemorrhage (SDH)
- subarachnoid haemorrhage (SAH)
- intra-axial haemorrhage
- ischaemic stroke
- 1. Greenberg MI. Greenberg's text-atlas of emergency medicine. Lippincott Williams & Wilkins. (2005) ISBN:0781745861. Read it at Google Books - Find it at Amazon
- 2. Lumenta CB, Rocco CD. Neurosurgery. Springer Verlag. (2009) ISBN:3540795642. Read it at Google Books - Find it at Amazon
- 3. Brust JC. Current diagnosis and treatment in neurology. McGraw-Hill Medical. (2006) ISBN:0071423664. Read it at Google Books - Find it at Amazon
- 4. Dayes LA, Purtzer TJ, Shahhal I et-al. Acute spontaneous cerebellar hemorrhage. J Natl Med Assoc. 1986;78 (6): 495-9. Free text at pubmed - Pubmed citation
- 5. Auer LM, Auer T, Sayama I. Indications for surgical treatment of cerebellar haemorrhage and infarction. Acta Neurochir (Wien). 1986;79 (2-4): 74-9. Pubmed citation