Clinical Feature and Outcome in Spontaneous Cerebellar Hemorrhage: Determination of Treatment Strategies

J Korean Neurol Assoc > Volume 22(4); 2004 > Article

Journal of the Korean Neurological Association 2004;22(4): 290-294.

자발성 소뇌출혈의 임상 양상 및 예후: 치료 방법의 결정

이상목, 정 부 이규용 이영주 정진환 김재민

한양대학교 의과대학 신경과학교실, 신경외과학교실

Clinical Feature and Outcome in Spontaneous Cerebellar Hemorrhage: Determination of Treatment Strategies

Sang Mok Lee

Departments of Neurology and Neurosurgery*, Hanyang University College of Medicine, Seoul, Korea

Abstract

Background: Cerebellar hemorrhage may present with a wide spectrum of clinical manifestations, from a benign course with little to no neurological deficit to a rapidly fatal course with hydrocephalus and brainstem compression. However, controversy remains concerning the management of patients with cerebellar hemorrhage. The aim of this study was to set the criteria for conservative or surgical treatment and predictive factors of poor outcomes.
Methods: During the 5-year period from July 1997 through July 2002, a series of 64 consecutive patients with spontaneous cerebellar hemorrhage was evaluated. On admission, all patients underwent a standard neurological examination, and a computed tomography (CT) scan. The location and size of hematoma, hypertension, hydrocephalus, intraventricular hemorrhage and compression of quadrigeminal cistern on a CT scan were compared with the Glasgow coma scale (GCS) and Glasgow Outcome Scale (GOS).
Results: Patients with GCS scores of 13 or more at admission and with a hematoma of less than 15 mL showed good outcomes. Patients with GCS scores of 10 or less at admission or with a hematoma measuring 15 mL or more had poor outcomes. Patients with intraventricular hemorrhage (p<0.05), compression of quadrigeminal cistern (p<0.05), and hydrocephalus (p<0.05) in the brain CT had poor outcomes.
Conclusions: In treating patients with spontaneous cerebellar hemorrhage, an initial GCS and CT scan were quite helpful in determining treatment strategies. For patients whose CT scan show intraventricular hemorrhages, compression of the quadrigeminal cistern, and hydrocephalus, intensive therapy should be deemed necessary. Key Words: Spontaneous cerebellar hemorrhage, Treatment strategy, Prognosis, Glasgow outcome scale