Yanaka K, Meguro K, Fujita K, Narushima K, Nose T
Department of Neurosurgery, Tsukuba Medical Center, Ibaraki, Japan.
Neurosurgery. 1999 Dec;45(6):1323-7; discussion 1327-8. doi: 10.1097/00006123-199912000-00010.
The outcomes for patients with cerebellar hemorrhage are thought to be influenced by anatomic damage to the brainstem. In this study, we investigated the magnetic resonance imaging findings in the brainstem, to examine the relationship between the degree of brainstem damage and the outcomes for patients with spontaneous cerebellar hemorrhage who are in poor-grade condition.
The results for 31 patients with spontaneous cerebellar hemorrhage, with Glasgow Coma Scale scores of 8 or less at admission, who underwent magnetic resonance imaging examinations were reviewed. All patients underwent surgical intervention. The patients were divided into two groups according to their Glasgow Outcome Scale scores at the time of discharge, i.e., patients who experienced good recoveries or exhibited moderate disabilities (Group I, n = 8) and patients who exhibited severe disabilities, were in a persistent vegetative state, or had died (Group II, n = 23). We investigated obliteration of the fourth ventricle and the perimesencephalic cistern and the presence of hydrocephalus in initial computed tomographic scans and the presence of areas of high signal intensity in the brainstem in T2-weighted images.
Eight patients experienced good outcomes, and 23 patients experienced poor outcomes. The overall mortality rate was 32.3%. There were no significant differences between groups with respect to computed tomographic findings such as hematoma size, but the incidence of high signal intensities in the pons and midbrain in T2-weighted images for Group II was significantly higher than that for Group I (P < 0.01).
Magnetic resonance imaging clearly demonstrated brainstem damage, and high signal intensity in the brainstem was a significant prognostic factor for determining outcomes for patients with spontaneous cerebellar hemorrhage who were in poor-grade condition.
小脑出血患者的预后被认为受脑干解剖结构损伤的影响。在本研究中，我们调查了脑干的磁共振成像结果，以检验脑干损伤程度与低级别状态的自发性小脑出血患者预后之间的关系。
回顾了31例自发性小脑出血患者的结果，这些患者入院时格拉斯哥昏迷量表评分≤8分，均接受了磁共振成像检查。所有患者均接受了手术干预。根据出院时的格拉斯哥预后量表评分将患者分为两组，即恢复良好或有中度残疾的患者（第一组，n = 8）和有严重残疾、处于持续性植物状态或已死亡的患者（第二组，n = 23）。我们调查了初次计算机断层扫描中第四脑室和中脑周围脑池的闭塞情况及脑积水的存在情况，以及T2加权图像中脑干高信号强度区域的存在情况。
8例患者预后良好，23例患者预后不良。总死亡率为32.3%。两组在血肿大小等计算机断层扫描结果方面无显著差异，但第二组在T2加权图像中脑桥和中脑高信号强度的发生率显著高于第一组（P < 0.01）。
磁共振成像清楚地显示了脑干损伤，脑干高信号强度是判断低级别状态的自发性小脑出血患者预后的一个重要预后因素。
