Traumatic Cerebellar Hematoma: A Tertiary Care Experience of 23 Conservatively Managed Cases

Abstract

Context: Traumatic cerebellar hematomas are rare in comparison to nontraumatic cerebellar hematomas.

Aims: The aim of this study is to evaluate the prognostic factors and outcome determining factors with regard to conservatively managed isolated traumatic cerebellar hematoma.

Settings and design: Retrospective cohort study.

Materials and methods: A retrospective study of 23 patients of conservatively managed isolated posterior fossa hematoma, admitted between August 2018 and May 2020, was conducted in the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi. Each of the patients was evaluated in terms of age, sex, mode of injury, clinical presentation, comorbidity, the severity of injury, best motor response, Glasgow Coma Scale (GCS) at admission, computed tomography findings, and Glasgow Outcome Scale at discharge/death.

Statistical analysis: Chi-square test and unpaired t-test were used. P < 0.05 was deemed statistically significant.

Results: Mean volume of posterior fossa contusion was 8.9 ml. The cerebellar hemispheric (60.9%) location of hematoma was more common. Age at presentation (P = 0.0086), best motor response (P < 0.0001), severity of injury (P = 0.0002), GCS at admission (P < 0.0001), effacement of basal cistern (P < 0.0001), fourth ventricular compression and intraventricular hemorrhage (P = 0.0008), presence of hydrocephalus (P = 0.0142), subarachnoid hemorrhage (P = 0.0008), and volume of posterior fossa contusion (P = 0.0002) were significantly associated with outcome of posterior fossa contusion.

Conclusion: Traumatic cerebellar hematoma is rare. Conservatively managed cerebellar hematoma patients must be monitored closely for neurological and radiological status. Patients who show deterioration in neurological or radiological status require surgical intervention.

Keywords: Conservative management; outcome; traumatic cerebellar contusion; traumatic cerebellar hematoma; traumatic posterior fossa contusion; traumatic posterior fossa hematoma.

Figure 1

Non contrast computed tomography scan showing right lateral cerebellar bleed, with perilesional edema. (a) axial, (b) coronal and (c) sagittal views

Figure 2

(a) Axial computed tomography scan showing acute hematoma involving the medial aspect of the right cerebellar hemisphere/middle cerebellar peduncle with intraventricular extension. Significant perilesional edema and obstructive hydrocephalus also noted. (b) Axial computed tomography scan showing acute hematoma in superior aspect of the left cerebellar tonsil. Mild perilesional edema is also seen. (c) Axial computed tomography scan showing medial aspect of the right cerebellar bleed with evidence of intraventricular extension