Cerebellar hemorrhage
Cerebellar hemorrhage is a form of intracranial hemorrhage 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. tumor or vascular malformation) or due to supratentorial surgery (see remote cerebellar hemorrhage).
This article concerns itself with primary cerebellar hemorrhages.
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Epidemiology
The demographics of affected patients reflect those of patients with long term poorly controlled hypertension, and as such patients are usually elderly.
Cerebellar hemorrhages only account for approximately 10% of all intracerebral hemorrhages 3.
Clinical presentation
Clinical presentation depends on the size and speed of enlargement of the hemorrhage. Unlike pontine hemorrhages which are usually obvious to both the clinician and the patient, cerebellar hemorrhages, 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.
Radiographic features
CT
As with other hemorrhagic strokes, CT is usually the first, and often the only imaging investigation obtained.
As with other acute hemorrhages, cerebellar hemorrhages appear as regions of hyperdensity within the cerebellar hemispheres. Extension into the fourth ventricle or subarachnoid space is relatively common.
Treatment and prognosis
Unlike pontine hemorrhages, cerebellar hemorrhages 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 hemorrhage causes brainstem compression or is greater than 3cm in diameter (20-30mL) evacuation is beneficial 2.
Related Radiopaedia articles
Stroke and intracranial haemorrhage
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stroke and intracranial hemorrhage
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ischemic stroke
- general discussions
- scoring and classification systems
- signs
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- alexia without agraphia syndrome: PCA
- cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
- Balint syndrome: bilateral PCA
- internal capsule infarct
- ataxic hemiparesis syndrome: MCA perforators or basilar artery perforators
- lacunar infarct
- thalamic infarct
- Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
- top of the basilar syndrome
- striatocapsular infarct
- cerebellar infarct
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brainstem infarct
- midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Nothnagel syndrome: PCA
- Weber syndrome: PCA
- pontine infarct
- Brissaud-Sicard syndrome
- facial colliculus syndrome
- Gasperini syndrome: basilar artery or AICA
- inferior medial pontine syndrome (Foville syndrome): basilar artery
- lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
- locked-in syndrome: basilar artery
- Millard-Gubler syndrome: basilar artery
- Raymond syndrome: basilar artery
- medullary infarct
- Babinski-Nageotte syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- treatment options
- complications
-
intracranial hemorrhage
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intra-axial hemorrhage
- signs
- by region or type
- extra-axial hemorrhage
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intra-axial hemorrhage
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ischemic stroke
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