Traumatic cerebellar hematoma: A tertiary care experience of 23 conservatively managed cases

Rahul Singh; Nityanand Pandey; Ramit Singh

doi:10.4103/ajns.AJNS_309_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 882-888
DOI: 10.4103/ajns.AJNS_309_20

Original Article

Traumatic cerebellar hematoma: A tertiary care experience of 23 conservatively managed cases

Rahul Singh

Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh

,

Nityanand Pandey

Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh

,

Ramit Singh

Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh

› Author Affiliations

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.

Key-words:

Conservative management - outcome - traumatic cerebellar contusion - traumatic cerebellar hematoma - traumatic posterior fossa contusion - traumatic posterior fossa hematoma

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References

References
1 d'Avella D, Servadei F, Scerrati M, Tomei G, Brambilla G, Angileri FF, et al. Traumatic intracerebellar hemorrhage: Clinicoradiological analysis of 81 patients. Neurosurgery 2002;50:16-25.
2 Karasawa H, Furuya H, Naito H, Sugiyama K, Ueno J, Kin H. Acute hydrocephalus in posterior fossa injury. J Neurosurg 1997;86:629-32.
3 Takeuchi S, Takasato Y, Masaoka H, Hayakawa T. Traumatic intra-cerebellar haematoma: Study of 17 cases. Br J Neurosurg 2011;25:62-7.
4 D'Avella D, Cacciola F, Angileri FF, Cardali S, La Rosa G, Germanò A, et al. Traumatic intracerebellar hemorrhagic contusions and hematomas. J Neurosurg Sci 2001;45:29-37.
5 Sato K, Hinokuma K, Matsuzawa Y, Takehara S, Uemura K, Ninchoji T, et al. Clinical study of traumatic cerebellar contusion. No Shinkei Geka 1987;15:1285-9.
6 Liu K. Characteristics of diagnosis and treatment of traumatic intracerebellar hemorrhage. Zhonghua Wai Ke Za Zhi 1997;35:166-7.
7 Patnaik A, Mahapatra AK. Traumatic cerebellar haematoma: A review. Indian J Neurotrauma 2013;10:24-9.
8 Glowacki JW. Posttraumatic cerebellar contusions and hematomas. In: Frowein RA, editors. Celebral Contusions, Lacerations and Hematomas. Advances in Neurotraumatology. Vol. 3., Vienna: Springer-Verlag Wien; 1991.
9 Kulshreshtha V, Tripathi P, Jaiswal G, Gupta TK. Traumatic cerebellar haematoma in paedratic patient – A case report and review of literature. Rom Neurosurg 2016;30:566-72.
10 Sokol JH, Rowed DW. Traumatic intracerebellar haematoma. Surg Neurol 1978;10:340-1.
11 Van Gijn J. From the archives. Brain 2007;130:4-7.
12 Braga LW, Souza LN, Najjar YJ, Dellatolas G. Magnetic resonance imaging (MRI) findings and neuropsychological sequelae in children after severe traumatic brain injury: The role of cerebellar lesion. J Child Neurol 2007;22:1084-9.
13 Buczek M, Jagodziński Z, Kopytek M, Dabrowska E. Conservative treatment of post-traumatic intracerebellar hematoma. Wiad Lek 1989;42:550-5.
14 Nashimoto T, Sasaki O, Nozawa T, Ando K, Kikuchi B, Watanabe M. Clinical study on cerebellar contusion: A report on 9 cases and literature review. No Shinkei Geka 2015;43:901-6.
15 Pollak L, Rabey JM, Gur R, Schiffer J. Indication to surgical management of cerebellar hemorrhage. Clin Neurol Neurosurg 1998;100:99-103.
16 Aghi M, Ogilvy CS, Carter B. Surgical management of intracerebral hemorrhage. In: Roberts DW, Schmidek HH, editors. Schmidek and Sweet's Operative Neurosurgical Techniques, Indications, Methods, and Results. 5th ed., Vol. 2. Philadelphia: Saunders/Elsevier; 2005. p. 1061-74.
17 Pozzati E, Grossi C, Padovani R. Traumatic intracerebellar hematomas. J Neurosurg 1982;56:691-4.
18 Yokota H, Mizunari T, Kuzuhara M, Kobayashi S, Yajima K, Nakazawa S, et al. Traumatic delayed intracerebellar hematoma. Neurol Med Chir (Tokyo) 1988;28:886-90.
19 Tsai FY, Teal JS, Itabashi HH, Huprich JE, Hieshima GB, Segall HD. Computed tomography of posterior fossa trauma. J Comput Assist Tomogr 1980;4:291-305.