Cerebellar Hemorrhage Clinical Presentation

  • Author: J Stephen Huff, MD; Chief Editor: Helmi L Lutsep, MD   more...
 
Updated: Apr 24, 2012
 

History

  • 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
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Physical

  • 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
    • Noncardiac or neurogenic cardiopulmonary complications may include findings of pulmonary edema, hypertension, bradycardia, and arrhythmia.[3]
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Causes

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
  • Amyloid angiopathy
  • 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.
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Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Canadian Congress of Neurological Sciences, Canadian Congress of Neurological Sciences, Canadian Congress of Neurological Sciences, Canadian Critical Care Society, Canadian Medical Protective Association, Canadian Neurocritical Care Society, Neurocritical Care Society, Royal College of Physicians and Surgeons of Canada, and Society of Critical Care Medicine (USA)

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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 Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

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

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

Disclosure: Co-Axia Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

References

  1. Brockmann MA, Groden C. Remote cerebellar hemorrhage: a review. Cerebellum. 2006;5(1):64-8. [Medline].

  2. Konya D, Ozgen S, Pamir MN. Cerebellar hemorrhage after spinal surgery: case report and review of the literature. Eur Spine J. Jan 2006;15(1):95-9. [Medline].

  3. Young YR, Lee CC, Sheu BF, Chang SS. Neurogenic cardiopulmonary complications associated with spontaneous cerebellar hemorrhage. Neurocrit Care. 2007;7(3):238-40. [Medline].

  4. Amar AP. Controversies in the neurosurgical management of cerebellar hemorrhage and infarction. Neurosurg Focus. Apr 2012;32(4):E1. [Medline].

  5. [Guideline] Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. Jun 2007;38(6):2001-23. [Medline].

  6. [Guideline] Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Sep 2010;41(9):2108-29. [Medline].

  7. St Louis EK, Wijdicks EF, Li H. Predicting neurologic deterioration in patients with cerebellar hematomas. Neurology. Nov 1998;51(5):1364-9. [Medline].

  8. Mohadjer M, Eggert R, May J, Mayfrank L. CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results. J Neurosurg. Aug 1990;73(2):217-22. [Medline].

  9. Yamamoto T, Nakao Y, Mori K. Endoscopic hematoma evacuation for hypertensive cerebellar hemorrhage. Minim Invasive Neurosurg. Jun 2006;49(3):173-8. [Medline].

  10. Deininger MH, Adam A, Van Velthoven V. Free-hand bedside catheter evacuation of cerebellar hemorrhage. Minim Invasive Neurosurg. Feb 2008;51(1):57-60. [Medline].

 
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Large hemorrhage of cerebellar vermis.
 
 
 
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