van der Hoop R G, Vermeulen M, van Gijn J
Department of Neurology, University Hospital Utrecht, The Netherlands.
Surg Neurol. 1988 Jan;29(1):6-10. doi: 10.1016/0090-3019(88)90115-2.
We have reviewed the records of 22 patients with spontaneous cerebellar hemorrhage. One question that we considered was whether the increased recognition of this disorder, since the introduction of computed tomography (CT) scanning, had brought about a change in the associated signs and symptoms, as compared with previous series. No such change was found. Nine patients died, four after operation (ventricular shunting in one, clot evacuation in one, both procedures in two patients). The five other patients were considered inoperable, because they showed signs of compression of the caudal brainstem. It is improbable that any of these five could have been saved by immediate ventricular drainage, advocated by some as the only treatment. Thirteen patients were treated conservatively and recovered, although four had a hematoma larger than 3 cm. All these patients had a Glasgow coma scale score of 11 points or more. The level of consciousness may be a better guide in management than the size of the clot.
我们回顾了22例自发性小脑出血患者的病历。我们思考的一个问题是，自计算机断层扫描（CT）引入以来，对这种疾病认识的增加是否导致了相关体征和症状与之前的系列研究相比有所变化。未发现此类变化。9例患者死亡，4例死于手术后（1例进行脑室分流，1例清除血肿，2例同时进行了这两种手术）。另外5例患者被认为无法进行手术，因为他们表现出尾端脑干受压的迹象。这5例患者中不太可能有任何一例能通过一些人主张的唯一治疗方法——立即进行脑室引流而获救。13例患者接受了保守治疗并康复，尽管其中4例血肿大于3厘米。所有这些患者的格拉斯哥昏迷量表评分均为11分或更高。在治疗中，意识水平可能比血肿大小更具指导意义。
