title: Space-occupying cerebellar infarction. Clinical course and prognosis.
abstract: OBJECTIVE
  Because the timing and strategy of surgical intervention in massive cerebellar infarction remains controversial, we report our experience with the management of 52 such patients.
  
  
  METHODS
  Case records, computed tomographic scans, surgical reports, and angiograms of 52 patients with space-occupying cerebellar infarction defined by computed tomographic criteria were reevaluated with regard to clinical course, etiology, therapeutic management, mortality, and functional outcome.
  
  
  RESULTS
  In most cases clinical deterioration started on the third day after stroke, and a comatose state was reached within 24 hours. Sixteen patients were treated medically, and 30 by suboccipital craniectomy (22 plus ventriculostomy, 12 plus tonsillectomy). Ten patients primarily had ventriculostomy, which in 4 patients was supplemented by craniotomy because of continuing deterioration. Twenty-nine patients made a good recovery, 15 remained disabled, and 8 died. Even comatose patients had a 38% chance of a good recovery with decompressive surgery. Age older than 60 years (P = .0043) and probably initial brain stem signs (P = .0816) and a late clinical stage (P = .0893) were linked with a fatal or disabling outcome.
  
  
  CONCLUSIONS
  Decompressive surgery should be the treatment of choice for massive cerebellar infarction causing progressive brain stem signs or impairment of consciousness.
authors.affiliation: Department of Neurology, Justus Liebig University, Giessen, Germany.
authors.forename: C R
authors.initials: CR
authors.lastname: Hornig
authors.forename: D S
authors.initials: DS
authors.lastname: Rust
authors.forename: O
authors.initials: O
authors.lastname: Busse
authors.forename: M
authors.initials: M
authors.lastname: Jauss
authors.forename: A
authors.initials: A
authors.lastname: Laun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001933:Brain Stem / Q000503:physiopathology; D002526:Cerebellar Diseases / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002544:Cerebral Infarction / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003128:Coma; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome