Postoperative brainstem high intensity is correlated with poor outcomes for patients with spontaneous cerebellar hemorrhage.
OBJECTIVE
The outcomes for patients with cerebellar hemorrhage are thought to be influenced by anatomic damage to the brainstem. In this study, we investigated the magnetic resonance imaging findings in the brainstem, to examine the relationship between the degree of brainstem damage and the outcomes for patients with spontaneous cerebellar hemorrhage who are in poor-grade condition.


METHODS
The results for 31 patients with spontaneous cerebellar hemorrhage, with Glasgow Coma Scale scores of 8 or less at admission, who underwent magnetic resonance imaging examinations were reviewed. All patients underwent surgical intervention. The patients were divided into two groups according to their Glasgow Outcome Scale scores at the time of discharge, i.e., patients who experienced good recoveries or exhibited moderate disabilities (Group I, n = 8) and patients who exhibited severe disabilities, were in a persistent vegetative state, or had died (Group II, n = 23). We investigated obliteration of the fourth ventricle and the perimesencephalic cistern and the presence of hydrocephalus in initial computed tomographic scans and the presence of areas of high signal intensity in the brainstem in T2-weighted images.


RESULTS
Eight patients experienced good outcomes, and 23 patients experienced poor outcomes. The overall mortality rate was 32.3%. There were no significant differences between groups with respect to computed tomographic findings such as hematoma size, but the incidence of high signal intensities in the pons and midbrain in T2-weighted images for Group II was significantly higher than that for Group I (P < 0.01).


CONCLUSIONS
Magnetic resonance imaging clearly demonstrated brainstem damage, and high signal intensity in the brainstem was a significant prognostic factor for determining outcomes for patients with spontaneous cerebellar hemorrhage who were in poor-grade condition.
Yanaka
K
K
Department of Neurosurgery, Tsukuba Medical Center, Ibaraki, Japan.
Meguro
K
K
Fujita
K
K
Narushima
K
K
Nose
T
T
D000368:Aged; D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001933:Brain Stem / Q000473:pathology*; D002526:Cerebellar Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D003399:Craniotomy; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D015996:Survival Rate; D014057:Tomography, X-Ray Computed