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Cerebellar Hemorrhage Clinical Presentation

  • Author: J Stephen Huff, MD, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
Updated: Apr 23, 2014


See the list below:

  • Onset of symptoms is generally abrupt.
  • Presentation varies greatly, depending on the size and location of the hemorrhage. Some patients are alert with headache and perhaps vomiting; others may be unresponsive with impaired or absent brainstem reflexes.
  • The following symptoms are roughly in descending order of incidence:
    • Headache of abrupt onset
    • Nausea and vomiting
    • Inability to walk (reflecting truncal ataxia)
    • Dizziness, vertigo
    • Dysarthria
    • Nuchal pain
    • Loss or alteration of consciousness


See the list below:

  • Physical examination findings also are variable. Some patients are alert and cooperative, while others are in a coma.
  • Signs generally are of abrupt onset and may change suddenly with progressive expansion of hematoma.
  • Signs tend to cluster with level of consciousness.
    • Diminished level of consciousness (uncooperative to comatose)
      • Irregular respirations
      • Extensor plantar responses
      • Impaired oculocephalic responses and a variety of other abnormal eye movements
      • Decreased or absent corneal responses
      • Impaired or absent pupillary responses
    • Lateralizing cerebellar signs may be present in a patient who is alert enough to cooperate with examination.
      • Limb ataxia
      • Dysarthria
      • Possible presence of extensor plantar responses (unilateral or bilateral)
      • Nuchal rigidity
      • Nystagmus
      • Gaze palsy (ipsilateral to hematoma)
      • Facial weakness
    • Gait difficulty in patients able to cooperate is a nonspecific finding.
    • Noncardiac or neurogenic cardiopulmonary complications may include findings of pulmonary edema, hypertension, bradycardia, and arrhythmia.[3]


Causes are similar to those of other types of intracranial hemorrhage. Approximately two thirds of CHs are believed to be hypertensive hemorrhages.

  • Hypertension - Suspected rupture of small penetrating vessels
  • Anticoagulant use
  • Blood dyscrasias
  • Arteriovenous malformation rupture
  • Sympathomimetic drug use
  • Hemorrhage into tumor
  • Dural leak or large CSF removal associated with supratentorial surgery, spinal surgery, or spontaneous intracranial hypotension.
Contributor Information and Disclosures

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD, FACEP is a member of the following medical societies: American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Neurological Association, American Society of Neurorehabilitation, American Academy of Neurology, American Heart Association, American Medical Association, National Stroke Association, Phi Beta Kappa, Tennessee Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Additional Contributors

Draga Jichici, MD, FRCP, FAHA Associate Clinical Professor, Department of Neurology and Critical Care Medicine, McMaster University School of Medicine, Canada

Draga Jichici, MD, FRCP, FAHA is a member of the following medical societies: American Academy of Neurology, Royal College of Physicians and Surgeons of Canada, Canadian Medical Protective Association, Canadian Medical Protective Association, Neurocritical Care Society, Canadian Critical Care Society, Canadian Critical Care Society, Canadian Neurocritical Care Society, Canadian Neurological Sciences Federation

Disclosure: Nothing to disclose.

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Large hemorrhage of cerebellar vermis.
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