Acute obstructive hydrocephalus caused by cerebellar infarction. Treatment Alternatives

Horwitz, Norman H.; Ludolph, Carol

doi:10.1016/0090-3019(83)90099-x

Cited by 30 publications

(15 citation statements)

References 17 publications

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“…[41][42][43] A large infarction of the cerebellum is often followed by delayed swelling. Although the early symptoms may be limited to impaired function of the cerebellum, oedema can cause brain stem compression and can rapidly progress to loss of brain stem function.…”

Section: Neurosurgerymentioning

confidence: 99%

Posterior circulation ischaemic stroke

Merwick

Werring

2014

BMJ

176

111

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Summary pointsPosterior circulation stroke accounts for 20-25% (range 17-40%) of ischaemic strokes Posterior circulation transient ischaemic attacks may include brief or minor brainstem symptoms and are more difficult to diagnose than anterior circulation ischaemia Specialist assessment and administration of intravenous tissue plasminogen activator are delayed in posterior circulation stroke compared with anterior circulation strokeThe risk of recurrent stroke after posterior circulation stroke is at least as high as for anterior circulation stroke, and vertebrobasilar stenosis increases the risk threefold Acute neurosurgical input may be needed in patients with hydrocephalus or raised intracranial pressure Basilar occlusion is associated with high mortality or severe disability, especially if blood flow is not restored in the vessel; if symptoms such as acute coma, dysarthria, dysphagia, quadriparesis, pupillary and oculomotor abnormalities are detected, urgently seek the input of a stroke specialist Sources and selection criteriaWe searched PubMed up to November 2013 with the terms "posterior circulation," "stroke," "ischaemic," and "vertebrobasilar," targeting full text English language studies published since 1990. We also searched the reference lists of the identified articles and our own files. Only papers published in English, or with an English abstract, were reviewed. The final selection of references was based on our judgment of relevance to the topic of this review.to Fabry's disease, a rare X linked inherited multisystem lysosomal storage disorder. 16 Similar to other forms of cerebrovascular and cardiovascular disease, the risk factors for posterior circulation strokes include hypertension, smoking, hypercholesterolaemia, atrial fibrillation, and coronary artery disease. What are the clinical symptoms and signs of posterior circulation ischaemia?Posterior circulation ischaemia can be challenging to recognise, particularly in patients with a TIA, which may have resolved by the time of presentation. However, there are some characteristic clinical patterns (box 1).Because the posterior circulation supplies the brainstem, cerebellum, and occipital cortex, symptoms often include dizziness, diplopia, dysarthria, dysphagia, disequilibrium, ataxia, and visual field deficits. Acute onset "crossed" deficits-cranial nerve territory symptoms on one side and sensory or motor deficits of the opposite arm and leg-are virtually diagnostic of posterior circulation ischaemia. 7 In a large single centre observational study of 407 patients, the most common posterior circulation symptoms were dizziness (47%), unilateral limb weakness (41%), dysarthria (31%), headache (28%), and nausea or vomiting (27%). The most common signs were unilateral limb weakness (38%), gait ataxia (31%), unilateral limb ataxia (30%), dysarthria (28%), and nystagmus (24%). 18In a large Chinese registry observational study of patients with posterior or anterior circulation stroke on confirmed magnetic resonance imaging, the signs with the highest...

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Section: Neurosurgerymentioning

confidence: 99%

Posterior circulation ischaemic stroke

Merwick

Werring

2014

BMJ

176

111

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“…Однако в течение нескольких дней у некоторых пациентов происходит значительное ухудшение состояния вследствие отека головного мозга с по-следующим сдавлением ствола головного мозга, трансфораминальным или транстенториальным вклинениями мозга, а также развитием окклюзи-онной гидроцефалии [1][2][3][4][5][6]. Несмотря на отсутст-вие результатов проспективных рандомизирован-ных исследований, в руководствах American Stroke Association [7] и European Stroke Organization [8] декомпрессионная субокципитальная краниэкто-мия (ДСК) и установка наружного вентрикулярно-го дренажа (НВД) в настоящее время рекомендова-ны в качестве предпочтительного метода лечения инфаркта мозжечка.…”

Section: Disclosuresunclassified

“…Согласно результатам некоторых исследований, проведение ДСК позволяет снизить уровень леталь-ности среди пациентов со злокачественным течением инфаркта мозжечка [2,3,6,[9][10][11][12][13][14][15][16][17]. Однако об отдален-ных исходах краниэктомии у выживших пациентов практически ничего неизвестно.…”

Section: Disclosuresunclassified

“…However, within a few days, a subset of patients dramatically deteriorates because of infarct swelling with consecutive brain stem compression, transforaminal or transtentorial herniation, and occlusive hydrocephalus. [1][2][3][4][5][6] Although results from prospective randomized trials are lacking, suboccipital decompressive craniectomy (SDC) and insertion of an external ventricular drainage (EVD) are currently recommended as the therapy of choice in the guidelines of the American Stroke Association 7 and the European Stroke Organization. 8 Numerous reports suggest that SDC reduces mortality in malignant cerebellar infarction.…”

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confidence: 99%

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Long-Term Outcome After Suboccipital Decompressive Craniectomy for Malignant Cerebellar Infarction

Pfefferkorn

Eppinger

Linn

et al. 2009

Stroke

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Background and Purpose-Suboccipital decompressive craniectomy (SDC) is a life-saving intervention for patients with malignant cerebellar infarction. However, long-term outcome has not been systematically analyzed. Methods-In this monocentric retrospective study we analyzed mortality, long-term functional outcome, and quality of life of all consecutive patients that were treated by SDC for malignant cerebellar infarction in our institution between 1995 and 2006. Results-A total of 57 patients were identified. All of them were treated by bilateral SDC. An external ventricular drainage was inserted in 82%, necrotic tissue was evacuated in 56% of patients. There were no fatal procedural complications. Five patients were lost for follow-up. In the remaining 52 patients, the mean follow-up interval was 4.7 years (1 to 11 years). Within the first 6 months after surgery 16 of 57 patients (28%) had died. At follow-up, 21 of 52 patients (40%) had died and 4 patients (8%) lived with major disability (mRS 4 or 5). Twenty-one patients (40%) lived functionally independent (mRS 0 to 2). The presence of additional brain stem infarction was associated with poor outcome (mRS Ն4; hazard ratio: 9.1; Pϭ0.001). Quality of life in survivors was moderately lower than in healthy controls. Conclusions-SDC is a safe procedure in patients with malignant cerebellar infarction. Infarct-but not procedure-related early mortality is substantial. Long-term outcome in survivors is acceptable, particularly in the absence of brain stem infarction.

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“…10,12,14,15 According to the American Stroke Association guidelines, decompressive surgical evacuation of space-occupying cerebellar infarction is effective in preventing and treating herniation and brain stem compression and was given a Class I/Level B evidence recommendation. 12 Emerging data indicate that the area of diffusion restriction on MRI may not represent complete permanent damage.…”

Section: Decompressive Surgerymentioning

confidence: 99%