In spontaneous cerebellar
hemorrhage emergency surgical intervention is often life-saving. Clinical features and the operative results of hypertensive cerebellar
hemorrhage (18 cases) were compared with those of
hemorrhage caused by small angiomas (7 cases). Hypertensive
hemorrhage occured most frequently in the seventh decades. Two thirds of the patients developed brainstem compression syndrome within a week from onset. One third remained awake or drowsy throughout their
clinical course. Surgical removal of a
hematoma was carried out in 13 patients with four deaths. Of note, two
comatose patients regained consciousness after surgery, and were discharged with residual
ataxia.
Rupture of a small
angioma occurred in younger patients. Their
clinical course was sub-acute or chronic associated with focal
cerebellar dysfunction. All seven surgically treated patients subsequently regained independent function. CT findings have been found helpful not only for diagnosis but also in defining appropriate
therapy.
Hematomas larger than 3 cm in diameter produced signs of rapidly progressing compression of the brainstem. Thereby, regardless of the cause of
bleeding, emergency removal of a clot is indicated even in awake patients.
Hematomas of 2 to 3 cm produced brainstem compression or prolonged
cerebellar dysfunction, and occasionally require
surgical decompression.
Hematomas smaller than 2 cm can be managed conservatively, since they were absorbed spontaneously in three weeks without residual functional disturbances. However, in case of a young patient exploration should be performed for a probable "cryptic"
angioma.