Kleinhirnblutung beim Neugeborenen

Kleinhirnblutung beim Neugeborenen

Cerebellar hemorrhage is a form of intracranial hemorrhage and is most frequently seen in the setting of poorly controlled hypertension, although this can of course also be secondary to an underlying lesion (e.g. tumor or vascular malformation) or due to supratentorial surgery (see remote cerebellar hemorrhage).

This article concerns itself with primary cerebellar hemorrhages.

Epidemiology

The demographics of affected patients reflect those of patients with long term poorly controlled hypertension, and as such patients are usually elderly.

Cerebellar hemorrhages only account for approximately 10% of all intracerebral hemorrhages .

Clinical presentation

Clinical presentation depends on the size and speed of enlargement of the hemorrhage. Unlike pontine hemorrhages which are usually obvious to both the clinician and the patient, cerebellar hemorrhages, if small enough, can present relatively subtly. Cerebellar signs (e.g. ataxia, nystagmus) . Larger bleeds can impair consciousness and obstruct the fourth ventricle resulting in obstructive hydrocephalus.

Radiographic features

CT

As with other hemorrhagic strokes, CT is usually the first, and often the only imaging investigation obtained.

As with other acute hemorrhages, cerebellar hemorrhages appear as regions of hyperdensity within the cerebellar hemispheres. Extension into the fourth ventricle or subarachnoid space is relatively common.

If there is no extension into the ventricular system, the volume of the hemorrhage can be estimated using ABC/2 and related formulas, which may have neurosurgical and prognostic implications.

Treatment and prognosis

Unlike pontine hemorrhages, cerebellar hemorrhages carry a relatively good prognosis if timely evacuation and control of hydrocephalus can be obtained.

Prompt diagnosis and neurosurgical referral are therefore key. Typically if a hemorrhage causes brainstem compression or is greater than 3 cm in diameter (20-30 mL) then evacuation is beneficial .

intrakranielle Blutung bei Neugeborenen

Intracranial hemorrhage (ICH) is a collective term encompassing many different conditions characterized by the extravascular accumulation of blood within different intracranial spaces. A simple categorization is based on location:

• intra-axial hemorrhage
  • intracerebral hemorrhage
    • basal ganglia hemorrhage
    • lobar hemorrhage
    • pontine hemorrhage
    • cerebellar hemorrhage
• extra-axial hemorrhage
  • extradural hemorrhage (EDH)
  • intralaminar dural hemorrhage
  • subdural hemorrhage (SDH)
  • subarachnoid hemorrhage (SAH)
  • intraventricular hemorrhage (IVH)
  • subpial hemorrhage

Alternatively, intracranial hemorrhage can be thought of in terms of the underlying cause, although in most cases the same etiology can result in multiple different patterns of hemorrhage.

• trauma
  • extradural hemorrhage (EDH)
  • subdural hemorrhage (SDH)
  • subarachnoid hemorrhage (SAH)
  • cerebral hemorrhagic contusion
• vascular malformation(s)
  • berry aneurysm
  • mycotic aneurysm
  • arteriovenous malformation (AVM)
  • dural arteriovenous fistula (DAVF)
• tumor related hemorrhage
• hypertension: hypertensive hemorrhage
• cerebral amyloid angiopathy (CAA)
• cerebral venous thrombosis

Radiographic features

CT

CT scan is almost always the first imaging modality used to assess patients with suspected intracranial hemorrhage. Fortunately, acute blood is markedly hyperdense compared to brain parenchyma, and as such usually poses little difficulty in diagnosis (provided the amount of blood is large enough, and the scan is performed early).

CT angiography (CTA) is increasingly used to assess for a vascular underlying cause, particularly in cases of subarachnoid hemorrhage, or intraparenchymal hemorrhage where something in the presentation, demographics of the patient, or location/appearance of bleed make a primary hemorrhage less likely.

Similarly, CT venogram (CTV) can be used to reliably assess for patency of the dural venous sinuses.

MRI

MRI is typically requested when an underlying abnormality is being sought, particularly when an underlying tumor is suspected. MRI of hemorrhage can pose some challenges in that the appearance of blood changes depending on the sequence and the time since the hemorrhage and the size and location of the bleed.

Angiography

Cerebral angiography is usually performed when a vascular abnormality is suspected and the CT/MR angiogram is either normal (and index of suspicion is high) or equivocal, or in cases where further delineation or treatment of an identified abnormality is required.

Siehe auch:

• intrakranielle Blutung bei Neugeborenen