Cerebellar Hemorrhage Clinical Presentation

Updated: Apr 19, 2022
  • Author: Sonal Mehta, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Onset of cerebellar hemorrhage (CH) 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



Physical examination findings in cerebellar hemorrhage (CH) 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. [7]



Causes of cerebellar hemorrhage (CH) are similar to those of other types of intracranial hemorrhage. Approximately two thirds of cerebellar 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. [9]

  • CADASIL [1]



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