From the Guidelines
Cerebellar hemorrhage symptoms include sudden severe headache, nausea, vomiting, difficulty walking, loss of coordination, dizziness, and problems with balance, and patients should seek emergency medical attention immediately if they experience these symptoms. The symptoms of cerebellar hemorrhage can vary, but they often include:
- Sudden severe headache
- Nausea and vomiting
- Difficulty walking or loss of coordination
- Dizziness or problems with balance
- Slurred speech or difficulty swallowing
- Vision changes, such as double vision
- Inability to look toward the side of the hemorrhage
- Decreased consciousness, coma, or abnormal posturing as the condition worsens
These symptoms typically appear suddenly and progress rapidly because blood accumulating in the posterior fossa creates pressure on the brainstem and fourth ventricle, potentially blocking cerebrospinal fluid flow, which can lead to hydrocephalus and increased intracranial pressure, life-threatening complications 1. The cerebellum controls coordination and fine motor movements, so damage to this area specifically causes ataxia (uncoordinated movements) and dysmetria (inability to judge distance and speed of movements).
The management of cerebellar hemorrhage often involves urgent surgical hematoma evacuation with or without external ventricular drainage (EVD) to reduce mortality in patients who are deteriorating neurologically, have brainstem compression and/or hydrocephalus from ventricular obstruction, or have cerebellar ICH volume ≥15 mL 1. It is essential to prioritize prompt treatment due to the limited space in the posterior fossa and proximity to vital brainstem structures.
In terms of treatment, urgent surgical hematoma evacuation with or without EVD is recommended to reduce mortality in patients with cerebellar ICH who are deteriorating neurologically, have brainstem compression and/or hydrocephalus from ventricular obstruction, or have cerebellar ICH volume ≥15 mL 1. The efficacy of surgical evacuation for improving functional outcomes is uncertain and has not been demonstrated in retrospective studies 1.
Overall, cerebellar hemorrhage is a serious condition that requires immediate medical attention, and prompt treatment can significantly improve outcomes. The most recent and highest quality study, published in 2022, provides the best guidance for the management of cerebellar hemorrhage 1.
From the Research
Symptoms of Cerebellar Hemorrhage
The symptoms of cerebellar hemorrhage can vary depending on the size of the hemorrhage and the degree of perilesional edema. Some common symptoms include:
- Sudden onset of severe headache
- Vomiting
- Dizziness
- Inability to walk
- Truncal ataxia
- Nystagmus
- Conjugate eyeball deviation
- Small miotic pupils with or without light reflex
- Abducens palsy
- Disturbance of consciousness, which is usually a late feature 2
- Neurological deterioration, including progressive disturbance of consciousness and hemiparesis 3
Clinical Presentation
The clinical presentation of cerebellar hemorrhage can range from symptoms mimicking ischemic stroke to catastrophic neurologic decline 4. The posterior fossa is a tight compartment with virtually no additional space to accommodate the mass effect, which can cause obstructive hydrocephalus and brainstem compression, contributing to early mortality 4.
Rare Complications
Remote cerebellar hemorrhage is a rare complication that can occur after spinal surgery, including lumbo-peritoneal shunt application 5 and intradural disc surgery 6. It can also occur after removal of a supratentorial glioma without perioperative CSF loss 3. Symptoms of remote cerebellar hemorrhage may include sudden headache, dizziness, nausea, and vomiting, and early diagnosis is important for optimal treatment 6.