Characteristics and Long-Term Outcome of Cerebellar Strokes in a Single Health Care Facility in Mexico

Villalobos-Díaz, Rodolfo; Ortiz-Llamas, Luz A; Rodríguez-Hernández, Luis A; Flores-Vázquez, José Guillermo; Calva-González, Metztli; Sangrador-Deitos, Marcos V; Mondragón-Soto, Michel G; Uribe-Pacheco, Rodrigo; Castro, Eliezer Villanueva; Barrera-Tello, Manuel A

doi:10.7759/cureus.28993

Cited by 3 publications

(9 citation statements)

References 26 publications

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“…That being said it is prudent to note that the National Institutes of Health Stroke Scale and modified National Institutes of Health Stroke Scale may underperform a clinical evaluation tool for patients with perturbations in the posterior circulation (eg, CS); accordingly, several studies have been using the GCS as for outcome analyses in such clinical scenarios. 4,[17][18][19][20] Similar to the widely used intracerebral hemorrhage score introduced by Hemphill et al, 7 the goal of this study was to establish a scoring system that is as simple as possible, and we therefore integrated the easy-to-acquire GCS as a proxy for clinical status. In line with such thinking, it is important to note that GCS remains critical for decisionmaking with regard to surgical decompressive treatment.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar Stroke Score and Grading Scale for the Prediction of Mortality and Outcomes in Ischemic Cerebellar Stroke

Won,

Melkonian,

Behmanesh

et al. 2023

Stroke

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BACKGROUND: Several individual predictors for outcomes in patients with cerebellar stroke (CS) have been previously identified. There is, however, no established clinical score for CS. Therefore, the aim of this study was to develop simple and accurate grading scales for patients with CS in an effort to better estimate mortality and outcomes. METHODS: This multicentric retrospective study included 531 patients with ischemic CS presenting to 5 different academic neurosurgical and neurological departments throughout Germany between 2008 and 2021. Logistic regression analysis was performed to determine independent predictors related to 30-day mortality and unfavorable outcome (modified Rankin Scale score of 4–6). By weighing each parameter via calculation of regression coefficients, an ischemic CS-score and CS-grading scale (CS-GS) were developed and internally validated. RESULTS: Independent predictors for 30-day mortality were aged ≥70 years (odds ratio, 5.2), Glasgow Coma Scale score 3 to 4 at admission (odds ratio, 2.6), stroke volume ≥25 cm 3 (odds ratio, 2.7), and involvement of the brain stem (odds ratio, 3.9). When integrating each parameter into the CS-score, age≥70 years and brain stem stroke were assigned 2 points, Glasgow Coma Scale score 3 to 4, and stroke volume≥25 cm 3 1 point resulting in a score ranging from 0 to 6. CS-score of 0, 1, 2, 3, 4, 5, and 6 points resulted in 30-day mortality of 1%, 6%, 6%, 17%, 21%, 55%, and 67%, respectively. Independent predictors for 30-day unfavorable outcomes consisted of all components of the CS-score with an additional variable focused on comorbidities (CS-GS). Except for Glasgow Coma Scale score 3 to 4 at admission, which was assigned 3 points, all other parameters were assigned 1 point resulting in an overall score ranging from 0 to 7. CS-GS of 0, 1, 2, 3, 4, 5, 6, and 7 points resulted in 30-day unfavorable outcome of 1%, 17%, 33%, 40%, 50%, 80%, 77%, and 100%, respectively. Both 30-day mortality and unfavorable outcomes increased with increasing CS-score and CS-GS ( P <0.001). CONCLUSIONS: The CS-score and CS-GS are simple and accurate grading scales for the prediction of 30-day mortality and unfavorable outcome in patients with CS. While the score systems proposed here may not directly impact treatment decisions, it may help discuss mortality and outcome with patients and caregivers.

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Section: Discussionmentioning

confidence: 99%

Cerebellar Stroke Score and Grading Scale for the Prediction of Mortality and Outcomes in Ischemic Cerebellar Stroke

Won,

Melkonian,

Behmanesh

et al. 2023

Stroke

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“…5,7,9,14,15 The generally accepted indication was a hematoma ≥3cm (13.5 cm 3 ) in width. 7,9,15,16 The other accepted indications included a patient with deteriorating conscious level or developing hydrocephalus secondary to 4 th ventricular obstruction. 7,15,16 But whether the surgical intervention improves clinical outcome remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,15,16 The other accepted indications included a patient with deteriorating conscious level or developing hydrocephalus secondary to 4 th ventricular obstruction. 7,15,16 But whether the surgical intervention improves clinical outcome remains controversial. 4,7,9,10,15 Satopää et al 5 and Kuramatsu et al, 9 in their study found that surgical evacuation of cerebellar hematoma did not lead to improved outcome.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome Following Surgical Evacuation of Spontaneous Cerebellar Hematomas

Altaf¹

2022

Pak J Neurol Surg

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Objective: debated. The present study was designed to analyze the clinical outcome of patients operated in our department for spontaneous cerebellar hematoma evacuation. Method: The medical data of all the patients in whom spontaneous cerebellar hematoma had been surgically evacuated were retrospectively analyzed. The parameters of age, preoperative Glasgow coma scales (GCS), and the volume of the hematoma was studied and their relationship with clinical outcome based on the Glasgow outcome scale (GOS) was analyzed Results: The study included twenty-four patients. Fourteen (58.3%) patients survived and ten (41.7%) patients expired. The mean age of the surviving patients was 57 years and the mean age of the expired patients was 57.2 years. The difference wasn’t statistically significant (p = 0.9612). The mean hematoma volume in the surviving patients was 23 cm3 and in the expired patients was 26.2 cm3. The difference didn’t reach statistical significance (p = 0.1614). The mean preoperative GCS of the surviving patients was 12.4 and of the expired patients were 8.3. This difference was statistically significant (p = 0.004). All the surviving patients had a favorable outcome based on the GOS score Conclusion: Surgical evacuation of cerebellar hematomas leads to a good clinical outcome. Preoperative GCS is significantly associated with the clinical outcome. The age of the patient and the volume of the hematoma were not found to be significantly associated with the clinical outcome

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“…Vascular accidents involving cerebellar blood supply are rare, thus outcomes associated with cerebellar strokes are understudied in comparison to cerebral strokes ( Feely, 1979 ; Marinković et al, 1995 ; Edlow et al, 2008 ). Cerebellar ischemic strokes, usually caused by cardioembolism or large vessel atherosclerotic disease ( Villalobos-Diaz et al, 2022 ), account for 2–3% of all ischemic strokes. Whereas cerebellar hemorrhagic strokes, mainly caused by vascular changes secondary to hypertension ( Tsitsopoulos et al, 2011 ; Villalobos-Diaz et al, 2022 ), account for 9–10% of all intracranial hemorrhages ( Villalobos-Diaz et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…Cerebellar ischemic strokes, usually caused by cardioembolism or large vessel atherosclerotic disease ( Villalobos-Diaz et al, 2022 ), account for 2–3% of all ischemic strokes. Whereas cerebellar hemorrhagic strokes, mainly caused by vascular changes secondary to hypertension ( Tsitsopoulos et al, 2011 ; Villalobos-Diaz et al, 2022 ), account for 9–10% of all intracranial hemorrhages ( Villalobos-Diaz et al, 2022 ). The cerebellum receives blood supply from the posterior inferior cerebellar artery (PICA), the anterior inferior cerebellar artery (AICA), and the superior cerebellar artery (SCA), branches of the basilar artery ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric outcomes following strokes involving the cerebellum: a retrospective cohort study

Muller Ewald,

Deifelt Streese,

Bruss

et al. 2023

Front. Neurosci.

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IntroductionGiven the wide-ranging involvement of cerebellar activity in motor, cognitive, and affective functions, clinical outcomes resulting from cerebellar damage can be hard to predict. Cerebellar vascular accidents are rare, comprising less than 5% of strokes, yet this rare patient population could provide essential information to guide our understanding of cerebellar function.MethodsTo gain insight into which domains are affected following cerebellar damage, we retrospectively examined neuropsychiatric performance following cerebellar vascular accidents in cases registered on a database of patients with focal brain injuries. Neuropsychiatric testing included assessment of cognitive (working memory, language processing, and perceptual reasoning), motor (eye movements and fine motor control), and affective (depression and anxiety) domains.ResultsResults indicate that cerebellar vascular accidents are more common in men and starting in the 5th decade of life, in agreement with previous reports. Additionally, in our group of twenty-six patients, statistically significant performance alterations were not detected at the group level an average of 1.3 years following the vascular accident. Marginal decreases in performance were detected in the word and color sub-scales of the Stroop task, the Rey Auditory Verbal Learning Test, and the Lafayette Grooved Pegboard Test.DiscussionIt is well established that the acute phase of cerebellar vascular accidents can be life-threatening, largely due to brainstem compression. In the chronic phase, our findings indicate that recovery of cognitive, emotional, and affective function is likely. However, a minority of individuals may suffer significant long-term performance impairments in motor coordination, verbal working memory, and/or linguistic processing.

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Characteristics and Long-Term Outcome of Cerebellar Strokes in a Single Health Care Facility in Mexico

Cited by 3 publications

References 26 publications

Cerebellar Stroke Score and Grading Scale for the Prediction of Mortality and Outcomes in Ischemic Cerebellar Stroke

Cerebellar Stroke Score and Grading Scale for the Prediction of Mortality and Outcomes in Ischemic Cerebellar Stroke

Clinical Outcome Following Surgical Evacuation of Spontaneous Cerebellar Hematomas

Neuropsychiatric outcomes following strokes involving the cerebellum: a retrospective cohort study

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