Laboratory Studies
Obtain coagulation studies and a platelet count in all patients, particularly those taking anticoagulant medication.
Obtain other admission laboratory work (including a specimen for blood type and crossmatch) if surgery is a possibility.
Imaging Studies
Computed tomography
Acute cerebellar hemorrhage (CH) should be visible as a hyperdensity in the posterior fossa.
Note the location of the hematoma (central versus lobar) and any sign of brainstem compression.
Note the absolute size of the clot in maximum diameter, and the volume of the hematoma.
Other signs of a posterior fossa mass include ablation of the fourth ventricle and/or compression of the ambient and quadrigeminal cisterns.
Note any obstructive hydrocephalus.
Follow-up imaging is generally recommended routinely within a 24-hr period, or immediately in case of any neurologic change, to evaluate for hematoma expansion, mass effect, or developing hydrocephalus.
Vascular imaging such as CT angiography, MR angiography, or catheter angiography of the intracranial vessels should be obtained to rule out the presence of an arteriovenous malformation, fistula, or aneurysm
CT angiography in acute CHs may demonstrate a "spot sign." In one study, amongst patients treated conservatively, the spot sign was seen in 12% of cases and was associated with larger hematomas, faster hematoma expansion, and worse functional outcome. The same study found that amongst patients treated surgically, the spot sign was more frequently seen, in 23% of patients, and was associated with higher mortality. CT angiography might thus serve as a useful prognostic tool as well. [10]
Magnetic resonance imaging
MRI may be important later in the clinical course to define vascular anatomy, extent of damage, and other pertinent intracranial abnormalities (eg, tumor, arteriovenous malformation, CAA [8] ).
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Large hemorrhage of cerebellar vermis.
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MRI demonstrating right cerebellar hemorrhage.
