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Journal of Korean Neurosurgical Society 1990;19(3): 343-349.
Methods of Treatment and Outcome of Primary Cerebellar Hemorrhage.
Jong Hyun Lim, Il Gyu Yun, Jae Won Doh, Hack Gun Bae, Kyeong Seok Lee, In Soo Lee
Department of Neurosurgery, Soonchunhyang University Chonan Hospital, Chonan, Korea.
We analysed a series of 35 patients with primary cerebellar hemorrhage, diagnosed by computerized tomography scanning from 1985 to 1988. They constituted 6.6% of spontaneous intracerebral hemorrhage(35 out of 530) who were admitted during the same period. There were 13 men and 22 women. The site of hemorrhage was vermis in 15 patients and hemisphere in 20 patients. On admission, the Glasgow Coma Scale(GCS) value was less than 10 in 15 patients(42.3%) and not less than 10 in 20 patients(57.1%). Quadrigeminal cistern was normal in 11 patients(31.4%), partially obliterated in 15 patients(42.9%) and completely obliterated in 9 patients(25.7%). The largest diameter of the hematoma was less than 3cm in 15 patients(42.9%) and larger than 3cm in 20 patients(57.2%). Hydrocephalic change was observed in 21 patients(60%). The hematoma was removed via suboccipital craniectomy in 16 patients(45.7%) and managed conservatively in 11 patients(31.4%). In 8 patients(22.9%), external ventricular drainage was performed. The method of treatment was different according to the GCS value on admission, the status of the quadrigeminal cistern, the presence of hydrocephalic change, and the size of hematoma. Overall mortality rate was 22.9%. These results suggested that the conservative treatment can be done in patients with (1) high GCS value(not less than 10), (2) patent quadrigeminal cistern, (3) absent hydrocephalic change, and (4) small sized hematoma(less than 3cm). If not surgical treatment should be considered.
Key Words: Primary cerebellar hemorrhage; Glasgow coma score; Quadrigeminal cistern; Hydrocephalic changes; Size of hematoma
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