Recurrent, sequential, bilateral deep cerebellar hemorrhages: a case report

Abstract

Introduction: Hypertensive intra-cerebral hemorrhage is usually a one-time event and recurrences are rare. Most recurrences develop as part of long-term failure of blood pressure control. The site of the re-bleed is usually limited to the basal ganglia and thalami.

Case presentation: We report the case of a 59-year-old hypertensive Caucasian woman who developed two sequential, right- and then left-sided, deep cerebellar hemorrhages. The second hemorrhage followed the first one by 57 days, at a time when her blood pressure was optimally controlled. In spite of these critical sites and short duration between the two bleeds, the patient achieved a relatively good functional recovery. Her brain magnetic resonance angiogram was unremarkable.

Conclusion: The development of recurrent hypertensive hemorrhage is rare and usually occurs within two years of the first bleed. To the best of our knowledge, this is the first reported case of bilateral, sequential, right- and then left-sided deep cerebellar hemorrhages. These hemorrhages were separated by eight weeks and the patient had a relatively good functional recovery. We believe that hypertension was the etiology behind these hemorrhages.

Figure 1

Non-contrast brain CT scan of the patient, which was done approximately four hours after developing her symptoms. Note that the hematoma lies at the deep right cerebellar hemisphere and is surrounded by mild cytotoxic edema. The fourth ventricle was not compressed and brainstem signs were absent.

Figure 2

Non-contrast brain CT scan of the same patient, which was done about 2 hours after the re-bleed. The second hemorrhage lies at the left deep dentate nuclei and is not surrounded by edema, implying a very recent development. The first hematoma at the right cerebellar hemisphere had resolved, leaving a small slit.