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Cerebellar Hemorrhage


Presentation

  • We present here a case of cerebellar hemorrhage presenting with nonsustained ventricular tachycardia (NSVT) in a 61-year-old man with no previously known medical problems.[ncbi.nlm.nih.gov]
  • We sought to determine the frequency of gastroenteritis-like presentations and delayed or missed diagnoses among patients with spontaneous cerebellar hemorrhage.[ncbi.nlm.nih.gov]
  • While intracranial hemorrhage is a known complication of AHA, intracranial hemorrhage as the presenting manifestation of AHA has only been described in three previous case reports.[ncbi.nlm.nih.gov]
  • Three patients with remote cerebellar hemorrhage following supratentorial cerebrovascular surgery are presented.[ncbi.nlm.nih.gov]
  • Supraventricular tachycardia may be an uncommon presenting rhythm that warrants considering cerebral etiology in patients without apparent cardiac risk.[ncbi.nlm.nih.gov]
Infectious Mononucleosis
  • The most common clinical manifestation of EBV is the syndrome of infectious mononucleosis. Central nervous system involvement by EBV is rare, with very few cases of EBV encephalitis reported in the literature.[ncbi.nlm.nih.gov]
Vomiting
  • At age 19, she experienced sudden headache with vomiting. The neurological examination showed ataxia, myoclonus and dystonia in the right upper extremity.[ncbi.nlm.nih.gov]
  • Such a complication is rare but should be considered after foramen magnum decompression surgery if the patient shows unusual symptoms of repeated vomiting.[ncbi.nlm.nih.gov]
  • In this small sample, misdiagnosed patients presented more often with normal mental state (100% vs. 35%, p 0.07) and nausea/vomiting (100% vs. 58%, p 0.22).[ncbi.nlm.nih.gov]
  • A 60-year-old man presented with severe occipital headache accompanied by nausea, vomiting, and dizziness that occurred while he was practicing the trumpet.[ncbi.nlm.nih.gov]
  • A 58-year-old male presented with a rare case of brain metastatic bronchogenic carcinoma with human chorionic gonadotropin (hCG) production causing cerebellar hemorrhage with symptoms of nausea, vomiting, and headache.[ncbi.nlm.nih.gov]
Nausea
  • In this small sample, misdiagnosed patients presented more often with normal mental state (100% vs. 35%, p 0.07) and nausea/vomiting (100% vs. 58%, p 0.22).[ncbi.nlm.nih.gov]
  • The patient complained of severe headache and nausea postoperatively. Brain computed tomography obtained 3 days after the surgery demonstrated remote cerebellar hemorrhage and hydrocephalus.[ncbi.nlm.nih.gov]
  • A 56-year-old woman was referred to our department with two-week history of headache, nausea, and poor appetite. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed dilated veins on the cerebellar surface.[ncbi.nlm.nih.gov]
  • A 60-year-old man presented with severe occipital headache accompanied by nausea, vomiting, and dizziness that occurred while he was practicing the trumpet.[ncbi.nlm.nih.gov]
  • The patient complained of repeated nausea and vomiting 3 hours after the operation, and computed tomography revealed remote cerebellar hemorrhage on postoperative day 1.[ncbi.nlm.nih.gov]
Withdrawn
  • After discussion with the patient's family, life-sustaining support measures were withdrawn. Postmortem analysis revealed a low FVIII activity level and the presence of FVIII inhibitor.[ncbi.nlm.nih.gov]
Dysuria
  • A 57-year-old Japanese woman presented to our hospital with back pain, dysuria, and numbness of both legs.[ncbi.nlm.nih.gov]
Headache
  • At age 19, she experienced sudden headache with vomiting. The neurological examination showed ataxia, myoclonus and dystonia in the right upper extremity.[ncbi.nlm.nih.gov]
  • Cerebellar symptoms, and even a late sudden headache after spinal surgery, may be signs of remote cerebellar hemorrhage, which is a rare complication.[ncbi.nlm.nih.gov]
  • One month after surgery, she had severe headache and vomiting immediately after taking some medications while in the protrusion position.[ncbi.nlm.nih.gov]
  • A 13-year-old boy presented to the emergency room with headaches and ataxia. Imaging studies revealed a cerebellar hemorrhage within a posterior fossa tumor. The patient underwent complete resection of this lesion and made a full recovery.[ncbi.nlm.nih.gov]
  • The hemorrhage manifested a few days postoperatively as a headache and transient loss of consciousness. Our patient recovered without further intervention with no major neurologic deficit.[ncbi.nlm.nih.gov]
Ataxia
  • The neurological examination showed ataxia, myoclonus and dystonia in the right upper extremity. Brain images demonstrated a hemorrhage in the right cerebellar hemisphere secondary to a cavernous malformation.[ncbi.nlm.nih.gov]
  • Her symptoms resolved completely, but she experienced progressive deterioration in auditory acuity and ataxia over the next 6 months.[ncbi.nlm.nih.gov]
  • The first patient was treated conservatively and had mild residual dysarthria and gait ataxia 2 months after surgery. The second patient underwent exploration and revision of the lumbar wound with primary dural repair.[ncbi.nlm.nih.gov]
  • A 13-year-old boy presented to the emergency room with headaches and ataxia. Imaging studies revealed a cerebellar hemorrhage within a posterior fossa tumor. The patient underwent complete resection of this lesion and made a full recovery.[ncbi.nlm.nih.gov]
  • Thirty-two months later, he was readmitted with complaints of occipital, neck, and shoulder pain as well as cerebellar ataxia.[ncbi.nlm.nih.gov]
Dizziness
  • A 60-year-old man presented with severe occipital headache accompanied by nausea, vomiting, and dizziness that occurred while he was practicing the trumpet.[ncbi.nlm.nih.gov]
  • One month later, he developed progressive dizziness, ataxia, and right-sided weakness. Magnetic resonance imaging revealed severe cerebellar and pontine edema.[ncbi.nlm.nih.gov]
  • Twelve hours after spinal surgery, she complained of unexpected dizziness, nausea, and vomiting. A total of 850 mL of serosanguineous fluid had been drained at that time, and drainage was stopped.[ncbi.nlm.nih.gov]
  • The wound was healing well and headache and dizziness also improved. He was discharged from the hospital on the 30 th day.[synapse.koreamed.org]
  • They frequently present with headache, nausea and vomiting, dizziness, and a striking difficulty standing or walking.[medlink.com]
Nystagmus
  • Abstract A 63-year-old woman presented with a metastatic focus of papillary thyroid carcinoma in the cerebellopontine angle manifesting as lateral gazing nystagmus and slurred speech.[ncbi.nlm.nih.gov]
  • A careful search for subtle cerebellar signs, including dysarthria, limb ataxia, nystagmus or tandem gait instability, absent in true gastroenteritis cases, could potentially reduce misdiagnosis.[ncbi.nlm.nih.gov]
  • On examination, he was disclosed mental confusion, repeated vomiting, constricred pupil, horizontal nystagmus, inability to stand, dysarthria and neck stiffness.[jkns.or.kr]
  • Cerebellar signs (e.g. ataxia, nystagmus) 1 . Larger bleeds can impair consciousness and obstruct the fourth ventricle resulting in obstructive hydrocephalus .[radiopaedia.org]
Dysarthria
  • The first patient was treated conservatively and had mild residual dysarthria and gait ataxia 2 months after surgery. The second patient underwent exploration and revision of the lumbar wound with primary dural repair.[ncbi.nlm.nih.gov]
  • Neurological examination after surgery revealed slight dysarthria after drainage of cerebrospinal fluid (CSF) but no other neurological deficits.[ncbi.nlm.nih.gov]
  • This became more severe, and developed progressive dysarthria and vomiting as well. Computed tomography demonstrated small sites of remote cerebellar hemorrhage in both cerebellar hemispheres.[ncbi.nlm.nih.gov]
  • On examination, he was disclosed mental confusion, repeated vomiting, constricred pupil, horizontal nystagmus, inability to stand, dysarthria and neck stiffness.[jkns.or.kr]
  • A careful search for subtle cerebellar signs, including dysarthria, limb ataxia, nystagmus or tandem gait instability, absent in true gastroenteritis cases, could potentially reduce misdiagnosis.[ncbi.nlm.nih.gov]

Workup

  • This case series will hopefully shed further light on the incidence, presentation, workup, and treatment of this particular complication of supratentorial surgery.[ncbi.nlm.nih.gov]
  • The initial diagnosis was aspiration pneumonia, but the patient became comatose 2 days after admission, and neuroradiological workup revealed cerebellar hemorrhage, obstructive hydrocephalus, and extensive destruction of the occipital bone secondary to[ncbi.nlm.nih.gov]
White Matter Lesions
  • Intravascular lymphoma (IVL) has been characterized in many case reports by multiple white matter lesions reflecting ischemic changes. In contrast, there are very few case reports of cerebral or cerebellar hemorrhage resulting from IVL.[ncbi.nlm.nih.gov]
Ischemic Changes
  • Intravascular lymphoma (IVL) has been characterized in many case reports by multiple white matter lesions reflecting ischemic changes. In contrast, there are very few case reports of cerebral or cerebellar hemorrhage resulting from IVL.[ncbi.nlm.nih.gov]

Treatment

  • Treatment consisted in external ventricular drainage in case 1 and conservative treatment in case 2. Both patients recovered without major neurological deficits.[ncbi.nlm.nih.gov]
  • It is suggested that EVD IVF is a treatment option for elderly patients with severe SCH IVH.[ncbi.nlm.nih.gov]
  • We report a severe adverse event occurring in the course of a cohort study (ISRCTN13784335) aimed at measuring the efficacy and safety of venous stenting in the treatment of patients with medically refractory idiopathic intracranial hypertension (IIH)[ncbi.nlm.nih.gov]
  • We also underline the importance of early diagnosis and CSF expansion in the early treatment of RCH.[ncbi.nlm.nih.gov]
  • Preoperative identification and work-up of the coagulation abnormality is essential to guide initial treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis depends largely on the severity of this bleeding.[ncbi.nlm.nih.gov]
  • Cerebellar stroke rarely causes disorders of higher brain function such as cognitive deficits and emotional dysfunction; hence, the prognosis of these patients is uncertain.[ncbi.nlm.nih.gov]
  • Intracerebral hemorrhages during HSS share a favorable prognosis and a posterior lobar localization, typically involving the parieto-occipital region.[ncbi.nlm.nih.gov]
  • Patient prognosis was scored by the Glasgow Outcome Scale (GOS) at discharge and we divided them into good outcome (GOS score of 4 or 5) and poor outcome (GOS score of 1 or 2 or 3) groups.[ncbi.nlm.nih.gov]
  • 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.[radiopaedia.org]

Etiology

  • Investigation for etiology of the hemorrhage included an MRI showing extensive subcortical ischemic disease and also several previous microbleeds.[ncbi.nlm.nih.gov]
  • No etiological factors for fetal hemorrhage were found other than a maternal heterozygocity for factor V Leiden.[ncbi.nlm.nih.gov]
  • Supraventricular tachycardia may be an uncommon presenting rhythm that warrants considering cerebral etiology in patients without apparent cardiac risk.[ncbi.nlm.nih.gov]
  • Not one single presurgical or surgical factor can reliably predict the occurrence of cerebellar hemorrhage after supratentorial craniotomy, and the etiology of this entity still remains unclear.[ncbi.nlm.nih.gov]
  • The only possible etiological factors identified in the reported case were opening of the dura and large-volume cerebrospinal fluid loss.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology Frequency United States An estimated 10% of intracerebral hemorrhages are believed to be cerebellar in location. An estimated 1-2% of strokes are CHs.[emedicine.medscape.com]
  • Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México. b Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México. c Department of Epidemiology[j-stroke.org]
  • View Article PubMed Google Scholar Thrift AG, Donnan GA, McNeil JJ: Epidemiology of intracerebral hemorrhage. Epidemiol Rev. 1995, 17 (2): 361-381. PubMed Google Scholar Auer RN, Sutherland GR: Primary intracerebral hemorrhage: pathophysiology.[jmedicalcasereports.com]
  • […] by 30 days after the insult, [7] and half of the deaths occur in the first 2 days. [29] Even though the majority of deaths occurs in the first days after ICH, survivors have a long term excess mortality of 27% compared to the general population. [30] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Severe congestion of upper cerebellar veins seemed to be a possible pathophysiology of this specific bleeding pattern.[ncbi.nlm.nih.gov]
  • The pathophysiological mechanism is disputed but is probably venous bleeding secondary to significant intraoperative or postoperative loss of cerebrospinal fluid.[ncbi.nlm.nih.gov]
  • Patients with Chiari type I malformation require neuroimaging follow up because the downward herniation of the tonsils can progress in association with subsequent pathophysiological disorders.[ncbi.nlm.nih.gov]
  • Although a number of theories have been proposed, the exact pathophysiology of RCH remains incompletely understood.[ncbi.nlm.nih.gov]
  • The pathophysiology remains unclear. Three cases of remote cerebellar hematoma occurred after neck clipping of anterior communicating artery aneurysms.[ncbi.nlm.nih.gov]

Prevention

  • We report a patient, having used aspirin for secondary stroke prevention, who had an acute cerebellar hemorrhage after taking nattokinase 400 mg daily for 7 consecutive days.[ncbi.nlm.nih.gov]
  • Metastasis of prostate cancer to the cranium, particularly to the skull base, rarely causes lower cranial nerve paresis, and awareness of this sign may lead to earlier detection of the cranial metastasis and prevention of cerebellar hemorrhage.[ncbi.nlm.nih.gov]
  • We discuss the possible pathophysiology, clinical course, treatment outcome, risk factors associated with such events and the importance of blood pressure control for preventing recurrence.[ncbi.nlm.nih.gov]
  • The left cerebellar hematoma was evacuated and the tumor was partially removed to prevent massive intraoperative hemorrhage and avoid brain stem injury.[ncbi.nlm.nih.gov]
  • Early recognition of redistributed drainage and preventive placement of coils at the origin of draining veins during the procedure could avert this rare complication.[ncbi.nlm.nih.gov]

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