Objective: To investigate the relation of surgical treatment with patient’s 180-day outcome. Subject and method: Thirty-six patients who suffered a first spontaneous cerebellar hemorrhage (SCH) were treated with operation from January 2017 to March 2022. This study aimed to identify potential clinical and computed tomography (CT) features influencing outcomes after 6 months from ictus, and the association of surgical treatment with SCH patients. Result: The mean age was 62.9 years (IQR 43–83 years). Hypertension was the most common underlying disease (31 patients, 86.1%), followed by smoking (15 patients, 41.7%). 63.9% (23/36) of patients showed loss of consciousness at the initial presentation. Among 36 patients, 25 patients (70%) underwent surgical hemorrhage evacuation with placement of an external ventricle drainage (EVD), 4 patients (10.4%) received an EVD only. The six-moth mortality rate was 33.33%, 12 patients (33.34%) had good outcome (modified Rankin Scale – mRS < 3). In multivariate analysis only the Glasgow coma scale (GCS) score and intracerebral hemorrhage (ICH) score on admission was significant predictor of six-month outcome ([odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.08-2.08, p=0.01; OR = 0.32, CI: 0.10–1.05, p=0.03), respectively. Conclusion: Surgical treatment can be effective for selected patients without lower GSC scores on admission. However, a higher ICH score on admission was associated with a 180-day outcome in patients with SCH.

Background: Osmotic demyelination syndrome (ODS) is characterized by widespread degeneration of myelin within the central nervous system (CNS) and has no established treatment. A limited number of cases have reported positive outcomes with corticosteroid in the treatment of ODS. We report the case of complete recovery of ODS with corticosteroid. Case presentation: A 48-year-old man presented with a stupor condition and exhausted. He was hospitalized at the Endocrinology Department with hyponatraemia, which was rapidly corrected with hypertonic saline from 103 to 116mmol/L. He was transferred to the Stroke Department because of worsening consciousness, arising rigidity and bradykinesia of the extremyties, worsening dysarthria and bradyphrenia. A brain magnetic resonance imaging (MRI) scan revealed later on pontine myelinolysis. He was commenced on corticoid 11 days after rapid correction of sodium. His status began to improve gradually after 10 days from starting of corticosteroid therapy and at 44 day-follow-up had no neurological deficit. Conclusion: Corticosteroid therapy can be considered as an effective treatment modality in osmotic demyelination syndrome.

Intraventricular hemorrhage (IVH), accounting for about 45% of acute spontaneous intracranial hemorrhage (ICH), is often associated with obstructive hydrocephalus and poor functional outcomes [1] [2]. Obstructive hydrocephalus and increased intracranial pressure are common after IVH because of an obstruction of normal cerebrospinal fluid (CSF) flow and absorption by blood clots. An external ventricular drain (EVD) - a temporary system that permits drainage of cerebral spinal fluid (CSF) from the ventricles to an external closed system) has been indicated for patients with IVH with hydrocephalus and neurologic decline [3]. However, the treatment with EVD alone is often not sufficiently effective due to a likely potential obstruction of the catheter by blood clots. Intraventricular fibrinolysis (IVF) via the extra-ventricular drain has been known to speed clot resolution and maintain the EVD functionality [4]. However, it is also possible that the risk of hemorrhage, infection, and CFS pleocytosis may be increased with IVF therapy, but these have not been demonstrated so far. We report a clinical case of primary IVH with acute obstructive hydrocephalus, successfully treated with a combination of EVD and direct intraventricular injection of rt-PA into the lateral ventricles. This treatment contributes to confirm that combination of EVD and thrombolysis could be considered as a treatment option for selected patients.