Cerebellar Hemorrhage Clinical Presentation

Updated: Dec 05, 2016
  • Author: Sonal Mehta, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Presentation

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
  • 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. [5]
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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
  • Anticoagulant use
  • Blood dyscrasias
  • Aneurysm/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.
  • CADASIL [1]
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