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Condition/Disorder Synonyms

  • Cerebellar hemorrhage

ICD-9-CM Code

  • 431 Intracerebral hemorrhage

ICD-10-CM Code

  • I61.4 Nontraumatic intracerebral hemorrhage in cerebellum

Preferred Practice Pattern1

Key Features

Description

  • Stroke, usually due to hemorrhage, affecting the hemispheres, vermis, or flocculonodular lobe of the cerebellum

Essentials of Diagnosis

  • Most prominent feature of acute cerebellar stroke is repeated vomiting

  • Patient will experience occipital headache, vertigo, difficulty remaining upright, walking

  • Most cases show mild unilateral facial weakness and decreased corneal reflex

  • May exhibit dysarthria or dysphagia

General Considerations

  • Can be life-threatening depending on size of hematoma

  • Generally hematoma causes pressure in area of the 4th ventricle

    • Blocking 4th ventricle leads to hydrocephalus

    • Increased pressure in area of the 4th ventricle causes damage to the brainstem

    • Patient's status can quickly deteriorate to coma as pressure builds

    • Cerebellar stroke due to hemorrhage considered medical emergency

Demographics

  • Can occur in any age group, either gender

Clinical Findings

Signs and Symptoms

  • Occipital headache

  • Vertigo

  • Vomiting

  • Mild facial weakness

  • Dysphagia

  • Dysarthria

  • Gait ataxia

  • Asthenia

  • Limb ataxia

  • Asynergia

  • Dyssynergia

  • Dysmetria

  • Dysdiadochokinesia

  • Tremor

  • Postural instability

  • Hypotonia

  • Nystagmus

  • Titubation

Functional Implications

  • Loss of independence with all aspects of mobility, ADLs, self-care

  • Safety concerns for any activity requiring upright control

  • Impaired ability to interact effectively with immediate and community environments

Possible Contributing Causes

  • Hypertension (HTN)

  • Arteriovenous malformation (AVM)

  • Hyperlipidemia

  • Obesity

  • Smoking

  • Sedentary lifestyle

  • Peripheral vascular disease

  • Birth trauma

Differential Diagnosis

  • Transient ischemic attack (TIA)

  • Hydrocephalus

  • Cerebellar ataxia

  • Cerebellar degeneration

Means of Confirmation or Diagnosis

Imaging

  • CT: accurate for cerebellar hemorrhage; to determine need for surgical evacuation

Diagnostic Procedures

  • Neurovascular tests

    • Neck flexion for meningeal irritation

    • Palpation of arteries

    • Auscultation of heart and blood vessels

    • Ophthalmic pressures

Treatment

Medications

  • Mannitol at initial identification of hydrocephalus

Referrals/Admittance

  • To emergency room to assessment and management of medical emergency

  • To neurosurgeon for surgical evacuation of cerebellar hematoma

  • To physiatrist for specific rehabilitation; physiatrist will manage medications, symptoms, future needs if not managed by neurologist

  • To occupational therapist for ADL, fine-motor task retraining

  • To speech/language pathologist for speech and swallowing impairments

  • To support groups for patients and caregivers

  • To case management or social work for coordination of care

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