A 45 year-old hypertensive man presented with nausea, vomiting and the inability to walk.
|Cerebellar Intracerebral Hemorrhage:
Axial CT scan. Note the area of high signal intensity in the
left cerebellum which denotes acute blood on CT imaging.
The cerebellum is one of the common locations for intracerebral hypertensive hemorrhage. If the hematoma expands, it can result in direct compression of the brainstem, or compression and obstruction of the fourth ventricle and secondary hydrocephalus. It is relatively uncommon for patients with a cerebellar hemorrhage to display limb ataxia of the arms or legs (classic cerebellar signs). They are much more likely to present with nausea, vomiting and the inability to walk.
Of all the possible locations for an intracerebral hemorrhage, the cerebellum is the most important to recognize early, as it is potentially treatable by surgical decompression and evacuation. If the hemorrhage results in compression of the fourth ventricle or aqueduct, acute hydrocephalus can develop, which is treatable by urgent shunting.
Copyrighted 2006. David C Preston