[Results of treatment of non-traumatic cerebellar haemorrhages].

AIM

Presentation of experiences in the treatment and tentative determination of factors of prognostic importance which could be useful in the selection of appropriate treatment of patients with non-traumatic cerebellar haemorrhage.

MATERIAL AND METHOD

35 consecutive patients treated in the years 1987-1996 were analysed retrospectively. Their condition on admission was assessed using Glasgow Coma Scale and the treatment results were assessed using the Glasgow Outcome Scale at the time of discharge. All patients had CT which was repeated, as necessary, and in some cases angiography was done. Ten patients were treated surgically and 25 only conservatively (in six of them temporary external ventricular drainage was performed due to hydrocephalus). The analysis included the influence of localisation and volume of haemorrhage, presence of hydrocephalus, intraventricular extension of haemorrhage fourth ventricle and quadrigeminal cistern appearance on the state of the patients and on treatment results. Non-parametric tests: Mann-Whitney and variance analysis of Kruskal-Wallis were used for determination of statistical significance (p < 0.05).

RESULTS

Six patients were in coma (4-7 GCS score), 6 had GCS score 8-12, 6 had GCS score 13-14, and 17 patients had no consciousness disturbances. Haematoma involved only cerebellar hemisphere in 21 cases, hemisphere and vermis in 12, cerebellum with brain stem extension in 2 cases. Haematoma volume was below 20 ml in 25 cases, over 20 ml in 5 cases, and in 5 case the volume could not have been determined. Hydrocephalus was present in 12 patients being related to CSF outflow block in 7 and to intraventricular haemorrhage in 5 cases. Intraventricular extension of haemorrhage occurred in 9 cases. Hydrocephalus presence (p = 0.005) and haematoma volume (p < 0.03) influenced significantly consciousness level on admission. In the surgically treated group 2 patients died and in 7 cases the result was satisfactory (GOS:MD + GR). In the group treated conservatively 4 patients died, 2 became disabled, and 19 left the hospital in good or very good condition (GOS:MD + GR). The total mortality was 17.2%, consciousness level on admission (p = 0.001), haematoma volume (p < 0.05), hydrocephalus presence (p < 0.008), intraventricular extension of haemorrhage (p < 0.008) had significant influence on treatment results.

CONCLUSIONS

In the light of our experience it is suggested that patients in coma should be operated on for haematoma evacuation with or without temporary external ventricular drainage. In conscious patients with stable course of disease medical treatment can be considered.