eMedicine Specialties > Neurology > Neurological Emergencies

Cerebellar Hemorrhage: Follow-up

Author: J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
Contributor Information and Disclosures

Updated: Dec 11, 2008

Follow-up

Further Inpatient Care

  • Ideally, admit patients to the care of critical care physicians with expertise in managing intracranial hemorrhages.
  • Careful monitoring for level of consciousness, vital signs, and ICP is needed for some patients.
  • The risk of sudden deterioration is high and mandates the attention that is available in an intensive care unit.
  • If immediate surgical intervention is deferred, a deteriorating clinical course may necessitate surgery at a later time.
    • Posterior fossa craniotomy and evacuation of the hemorrhage may be necessary for patients with worsening clinical condition.
    • If surgical therapy is prompt, some comatose patients still may have a good clinical outcome.
  • Physical and occupational therapy may be useful in patients who are in stable condition.

Further Outpatient Care

Physical and occupational therapy may be useful in many patients.

Transfer

For facilities without neurosurgical care for hemorrhage management, transfer to a specialized center should occur after stabilization if the patient is viable.

  • Transfer should occur only after discussion with an accepting physician.
  • Transfer personnel should be skilled in critical care management.

Complications

Progression of the hemorrhage with brainstem compression and/or destruction is the most serious complication.

Prognosis

Prognosis is related to the size and location of the hemorrhage and the patient's clinical condition at the time of clinical presentation.

Patient Education

For excellent patient education resources, visit eMedicine's Stroke Center. Also, see eMedicine's patient education article Stroke.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose and delayed diagnosis following clinical deterioration are common pitfalls.
    • Some patients with small, lateral CHs may experience no symptoms other than the common complaints of dizziness and headache. The natural history of this group is variable, although some undoubtedly deteriorate.
    • Patients with diminished level of consciousness or intractable vomiting may be unable to cooperate with examination, making detection of cerebellar signs difficult or impossible.
  • Testing the gait of any patient with a complaint of dizziness is important, particularly when dizziness is accompanied by any of the following symptoms: headache, nausea, or vomiting. CHs in the vermis may cause ataxia of the trunk without limb ataxia. Gait testing is helpful in diagnosis and is a common feature.

Special Concerns

Patients on warfarin therapy or another coagulopathy are difficult to treat. The coagulopathy should be aggressively treated. Surgical intervention prior to correction of the coagulopathy may be disastrous, yet delaying surgery may also have risks.

 


More on Cerebellar Hemorrhage

Overview: Cerebellar Hemorrhage
Differential Diagnoses & Workup: Cerebellar Hemorrhage
Treatment & Medication: Cerebellar Hemorrhage
Follow-up: Cerebellar Hemorrhage
Multimedia: Cerebellar Hemorrhage
References
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References

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Further Reading

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Keywords

CH, cerebellar bleeding, intracerebellar hemorrhage, stroke of the cerebellum, stroke, computed tomography, head CT, cranial CT

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Contributor Information and Disclosures

Author

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
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.

Medical Editor

Draga Jichici, BSc, MD, FRCP, Associate Clinical Professor, Department of Medicine, Division of Neurology and Critical Care Medicine, McMaster University, Canada
Disclosure: Biogen Honoraria Review panel membership; Sanofi Honoraria Speaking and teaching; Merk and Frost Honoraria Speaking and teaching; Teva Neurosciences Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Novartis Consulting fee Review panel membership

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
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: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health and Science University; 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; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Boston Scientific Honoraria Speaking and teaching; Concentric Medical None Review panel membership; Northstar Neuroscience  Review panel membership; ev3 Consulting fee Review panel membership

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