Cerebellar strokes: a clinical outcome review of 79 cases

Abstract

Introduction: Cerebellar infarcts and haemorrhages are relatively uncommon, accounting for less than 10% of all strokes. The objective of the present study was to quantify and compare the outcomes of patients with cerebellar infarct and those of patients with cerebellar haemorrhage, as well as to identify the risk factors that predict poor outcome in patients with cerebellar stroke.

Methods: We retrospectively reviewed the medical records of consecutive patients admitted to National University Hospital, Singapore, between 2004 and 2006, within one week of cerebellar stroke onset. Baseline data included demographics, concomitant comorbidities, and the presence or absence of brainstem compression and hydrocephalus (on computed tomography or magnetic resonance imaging). The Glasgow Outcome Scale and modified Rankin Score were used to assess outcome at discharge and at six months after discharge.

Results: A total of 79 patients with cerebellar stroke were admitted during the study period. Of these 79 patients, 17.7% died and 31.6% had poor outcomes at six months after discharge. Patients with cerebellar haemorrhage were found to be more likely to have poor outcomes as compared to patients with cerebellar infarct, both at discharge (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.3-14.1) and at six months after discharge (OR 5.2, 95% CI 1.6-17.2). When compared to small lesions (< 5 cm(3)), lesions > 20 cm(3) were significantly associated with poorer outcomes and the development of hydrocephalus and brainstem compression.

Conclusion: Cerebellar strokes are a significant cause of morbidity and mortality. The outcomes of patients with cerebellar haemorrhage are more likely to be worse than those of patients with cerebellar infarct.

Fig. 1

(a) CT image at admission shows a large right cerebellar haemorrhage with effacement of the fourth ventricle, brainstem compression and resultant hydrocephalus. (b) CT image after surgical decompression (i.e. large posterior fossa craniectomy and evacuation of haematoma) shows improvement of the mass effect.

Fig. 2

(a) CT image at admission shows an acute right cerebellar infarct. The patient was admitted for severe giddiness and difficulty in walking. (b) CT image at follow-up six months after discharge shows a large area of encephalomalacia, consistent with a previous infarct.