Cerebellar haemorrhage

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.

CT

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.

Unlike pontine haemorrhages, cerebellar haemorrhages carry a relatively good prognosis if timely evacuation and control of hydrocephalus can be obtained.

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
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Article Information

rID: 13412
Synonyms or Alternate Spellings:
  • Cerebellar hemorrhage
  • Cerebellar bleed
  • Cerebellar haemorrhages
  • Cerebellar hemorrhages
  • Cerebellar bleeds

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    Case 8: with intraventricular extension and obstructive hydrocephalus
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    Hypertensive haemorrhage with microhaemorrhages
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