Hypertensive Cerebellar Hemorrhage:Prognostic Factors.

Koh, Do Yle; Kim, Jung Hoon; Kwon, Yang; Rhim, Seung Chul; Lee, Jung Kyo; Kwun, Byung Duk; Whang, C Jin

Original Article

Journal of Korean Neurosurgical Society 1995;24(8): 894-904.

Do Yle Koh, Jung Hoon Kim, Yang Kwon, Seung Chul Rhim, Jung Kyo Lee, Byung Duk Kwun, C Jin Whang

Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

ABSTRACT

Hypertensive cerebellar hemorrhage was rarely diagnosed in the past and therefore thought to be infrequent, but after the introduction of computerized tomography(CT) scans it has been more commonly diagnosed. We present 36 patients with hypertensive cerebellar hemorrhage who were treated in our hospital from June 1989 to January 1994. There were 15 men and 21 women, with ages ranging between 34 and 91 years. The volume of cerebellar hematoma and the grade of quadrigeminal cisternal obliteration on CT scans significantly correlated to the level of consciousness at admission. Several prognostic factors which might influence the outcome were statistically analysed:the level of consciousness at admission, the volume of hematoma, the treatment modality, the presence of hydrocephalus, the presence of quadrigeminal cisternal obliteration on CT scans, and the location of hematoma. Overall mortality rate was 13.9% and many of the above factors affected the outcome except for the treatment modality and the presence of hydrocephalus. The outcome in patients with GCS scores of 14 or 15 at admission was excellent. We conclude that the level of consciousness at admission is the most important prognostic factor and surgical decompression is indicated particularly in patients with an impaired level of consciousness, provided that brainstem reflexes are still intact. An accurate monitoring of the patient's clinical status is very important since its worsening is an absolute indication for surgery independent of the size of hematoma.

Key Words: Hypertensive cerebellar hemorrhage; CT scans; Level of consciousness; Volume of hematoma; Prognostic factors; Outcome