Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Kobayashi, Shigeki; Satô, Akira; Kageyama, Yusuke; Nakamura, Hiroshi; Watanabe, Yoshirô; Yamaura, Akira

doi:10.1097/00006123-199402000-00006

Cited by 22 publications

(41 citation statements)

References 12 publications

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“…11,18,35 As with cerebellar infarction, cerebellar hemorrhage occurs most frequently in the 5th through the 8th decades of life and with greater frequency in males than in females. 11,18 Between 60% and 90% of all spontaneous cerebellar hemorrhages occur in hypertensive patients. Vascular malformations, coagulopathies (including the use of anticoagulants), neoplasms, aneurysms, cerebral amyloid angiopathy, and trauma account for the remainder.…”

Section: Pathophysiology and Natural Historymentioning

confidence: 99%

“…When deterioration occurs, mortality has been reported to be high (25%-100%), regardless of treatment. 1,7,17,18,30 Deterioration can occur unpredictably, even in patients who appear to have reached a clinical plateau. 11,17 Ott et al 25 reported that 50% of patients who remained alert and relatively stable for 2 days degenerated into coma over the course of the next several days, and a disconcerting 25% of patients who remained awake for 7 days subsequently deteriorated.…”

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confidence: 99%

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Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Amar

2012

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Evidence-based guidelines for the management of hemorrhagic and ischemic cerebellar stroke are sparse, and most available data come from Class III studies. As a result, opinions and practices regarding the nature and role of neurosurgical intervention vary widely. A comprehensive literature review was conducted to adjudicate several contentious issues, such as the difference in the management of cerebellar hemorrhage versus infarction, criteria for imaging to exclude an underlying structural lesion, the value of MRI for patient selection, the role of external ventricular drainage, the indications for operative management, the timing of surgical intervention, and various options of surgical technique, among others. Treatment algorithms proposed in several different studies are compared and contrasted. This analysis is concluded by a summary of the recommendations from the American Stroke Association, which advises that patients with cerebellar hemorrhage who experience neurological deterioration or who have brainstem compression and/or hydrocephalus due to ventricular obstruction should undergo surgical evacuation of the hemorrhage as soon as possible, and that initial treatment of such patients with ventricular drainage alone rather than surgical removal of the hemorrhage is not recommended.

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Section: Pathophysiology and Natural Historymentioning

confidence: 99%

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confidence: 99%

Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Amar

2012

FOC

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“…We found that smaller bleeds are better managed conservatively, while optimal management of moderate and large bleeds is inconclusive and there was no difference in the outcome at the end of three months. Generally patients with significant midline shift, acute hydrocephalus and deteriorating neurological status will require surgical evacuation [12][13][14][15], however the guidelines are clear for cerebellar haematoma [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Management of Spontaneous Intracerebral Haemorrhage

Swamy¹

2007

Medical Journal Armed Forces India

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Original Articlecare hospital, were included in the study. Glasgow coma scale (GCS) and the initial blood pressure were recorded at admission and after six hours. All the patients were evaluated with CT scan to assess the size, shape, location and volume of haematoma [17]. Based on the volume of the clot the bleed was grouped as small (<20 cc), moderate (21-40 cc) and large (>40 cc). Patients were also subjected to DSA CT angiography to rule out AVM/aneurysm and magnetic resonance imaging (MRI) to rule out tumour bleed. CT scan was repeated after six hours and on third day of admission in case of clinical deterioration.The criteria for surgical management in supratentorial SICH were patients less than 60 years of age, progressive neurological deficit, GCS of more than five, clot more than 40cc in volume, mass effect on CT scan and deterioration of neurological status while on conservative treatment. The medical management criteria were patients more than 60 years of age, GCS of five or less, clot less than 40 cc in size, brain stem extension and associated medical disorders.The criteria for surgical management in infratentorial SICH were patients with clot size of more than three centimeter in diameter, associated hydrocephalus, obliteration of brainstem cisterns and deterioration of neurological status. The medical management criteria were patients with clot size of less than three centimeter in diameter and GCS of less than five.Open craniotomy was used for evacuating the blood clot for treatment by surgical mode, while those conservatively managed were treated by decongestants.The patients were followed up for one month and after three months of discharge. The outcome was assessed based on Glasgow outcome scale at discharge, one month and three months after discharge. Introduction S pontaneous intracerebral haemorrhage (SICH) isresponsible for 10-15% of the acute stroke [1][2][3]. The common causes of SICH are hypertension, aneurysm, arteriovenous malformation (AVM), coagulopathies and vasculopathies [4][5][6]. Hypertensive bleed mainly occurs in putamen, near ruptured aneurismal site with or without subarachanoid haemorrhage/ventricular extension and at the site of AVM, while bleeding due to angiopathy is usually lobar [7,8]. The neurological status at the initial presentation and the interval between onset and therapeutic intervention contributes to the prognosis [9]. Computed tomography (CT) scan (level one evidence and grade A recommendation) for the initial assessement and digital substraction angiography (DSA) to establish or rule out aneurysm/arteriovenous malformations are the investigations of choice [10].The lack of consensus for the treatment of SICH has led to great variation in surgical and medical management [11][12][13]. Guidelines based on scant data from few randomised and many nonrandomised trials are uncertain at best [10]. All the studies emphasise on early evacuation of clot in case surgery is chosen as the treatment option [14][15][16]. This observational study aimed at identifying appro...

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“…In this case, it revealed extracellular methaemoglobin, indicating the There is no study comparing conservative and surgical approaches to subdural haematomas in the posterior cranial fossa. A conservative approach has been suggested in conscious patients with no radiological mass effect on the fourth ventricle and/or brain stem [11]. In one report [6], the patient was treated with an external ventricular catheter and the haematoma was followed conservatively, with a good clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI

2003

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Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Cited by 22 publications

References 12 publications

Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Controversies in the neurosurgical management of cerebellar hemorrhage and infarction

Management of Spontaneous Intracerebral Haemorrhage

Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI

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