Hematoma cerebelar espontâneo: análise de 23 casos

Rial, J. P.; Vilalta, J.; Guitart, J.M.; Rúbio, E.

doi:10.1590/S0004-282X1988000100010

Resumos

Uma série de 23 pacientes com hematoma espontâneo de cerebelo é analisada retrospectivamente, mostrando que: todos apresentavam algum grau de diminuição do nível de consciência e cefaléia; 12 apresentavam déficits motores dentre os sinais clínicos mais importantes. Dos antecedentes patológicos destacam-se hipertensão arterial (69,5%) e diabetes (34%), havendo associação de ambos em 30% dos casos. Dos aspectos da tomografia computadorizada (TC) mais relevantes a dilatação ventricular aguda, encontrada em 69,5% dos pacientes, associada ou não a presença de sangue intraventricular, é considerada sinal de mau prognóstico, indicando por si só terapêutica de urgência. A melhor abordagem cirúrgica para a maioria desses casos é a drenagem ventricular externa de urgência, reservando a craniectomia da fossa posterior para esvaziamento do hematoma para casos específicos. A mortalidade e a morbidade desta patologia é alta; porém, pela TC o diagnóstico se tornou mais rápido e eficiente. Os pacientes desta série puderam beneficiar-se deste procedimento, como se verifica quando comparados a pacientes de outras séries, diagnosticados por outros métodos.

A series of 23 patients with spontaneous cerebellar hematoma is analysed retrospectively. Several degrees of conciousness impairment, and headache occurred in all; 12 patients presented motor deficits among the more important clinical signs. Arterial hypertension (69,5%) and diabetes (34%) stand out in the pathological background, and their association was frequent (30%). Computerized tomography (CT) disclosing severe ventricular dilatation (69.5%) associated or not with intraventricular presence of blood is considered as an unsactisfatory prognosis sign, and indicative for emergency therapy. Emergency external ventricular draining is the best indication for the majority of these cases. Posterior fossa craniectomy for emptying the hematoma may be the indication in severe cases. Death and morbidity in this pathology are high as yet. However, CT contribution for diagnosis is quicker and better than benefits obtained through other methods. Results observed in the present series are illustrative on this statement, when compared to data of other series diagnosed through other methods.

J. P. Rial^I; J. Vilalta^II; J.M. Guitart^III; E. Rúbio^IV

^IAdjunto estrangeiro - Serviço de Neurocirurgia da Cidade Sanitária Vall d'Hebron, Barcelona, Espanha

^IIAdjunto - Serviço de Neurocirurgia da Cidade Sanitária Vall d'Hebron, Barcelona, Espanha

^IIIChefe de Clínica - Serviço de Neurocirurgia da Cidade Sanitária Vall d'Hebron, Barcelona, Espanha

^IVChefe do Serviço - Serviço de Neurocirurgia da Cidade Sanitária Vall d'Hebron, Barcelona, Espanha

RESUMO

Uma série de 23 pacientes com hematoma espontâneo de cerebelo é analisada retrospectivamente, mostrando que: todos apresentavam algum grau de diminuição do nível de consciência e cefaléia; 12 apresentavam déficits motores dentre os sinais clínicos mais importantes. Dos antecedentes patológicos destacam-se hipertensão arterial (69,5%) e diabetes (34%), havendo associação de ambos em 30% dos casos. Dos aspectos da tomografia computadorizada (TC) mais relevantes a dilatação ventricular aguda, encontrada em 69,5% dos pacientes, associada ou não a presença de sangue intraventricular, é considerada sinal de mau prognóstico, indicando por si só terapêutica de urgência. A melhor abordagem cirúrgica para a maioria desses casos é a drenagem ventricular externa de urgência, reservando a craniectomia da fossa posterior para esvaziamento do hematoma para casos específicos. A mortalidade e a morbidade desta patologia é alta; porém, pela TC o diagnóstico se tornou mais rápido e eficiente. Os pacientes desta série puderam beneficiar-se deste procedimento, como se verifica quando comparados a pacientes de outras séries, diagnosticados por outros métodos.

SUMMARY

A series of 23 patients with spontaneous cerebellar hematoma is analysed retrospectively. Several degrees of conciousness impairment, and headache occurred in all; 12 patients presented motor deficits among the more important clinical signs. Arterial hypertension (69,5%) and diabetes (34%) stand out in the pathological background, and their association was frequent (30%). Computerized tomography (CT) disclosing severe ventricular dilatation (69.5%) associated or not with intraventricular presence of blood is considered as an unsactisfatory prognosis sign, and indicative for emergency therapy. Emergency external ventricular draining is the best indication for the majority of these cases. Posterior fossa craniectomy for emptying the hematoma may be the indication in severe cases. Death and morbidity in this pathology are high as yet. However, CT contribution for diagnosis is quicker and better than benefits obtained through other methods. Results observed in the present series are illustrative on this statement, when compared to data of other series diagnosed through other methods.

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1. Brewer DB, Fawcet FJ, Horsfield GI - A necropsy series of cerebral hemorrhage with particular reference to heart weight. J Path Bact 96: 311, 1968.
2. Canales M, Garibi J, Uriguen M, Diaz-Aramendi A - Hemorragia cerebelosa espontánea. Rev Neurol (Barcelona) 9: 301, 1984.
3. Chin D, Carney P - Acute cerebelar hemorrhage with brainsten compression in contrast with benign cerebelar hemorrhage. Surg Neurol 19: 406, 1983.
4. Forgeau Y, Mussini JM, Ponge T, Bricout H - Les hématomes spontanés primitifs du cervelet. Arch Anat Cytol Path 32: 173, 1984.
5. Freeman RE, Onofrio BM, Okazaki A, Dinapoli RP - Spontaneous intracerebelar hemorrhage: diagnosis and surgical treatment. Neurology 23: 84, 1973.
6. Furlan AJ, Whisnant JP, Elverack LR - The decreasing incidence of primary intracerebelar hemorrhage. Ann Neurol 5: 367, 1979.
7. Jennett B, Bond M - Assessment of outcome after severe brain damage. Lancet 1: 480, 1975.
8. Labauge R, Boukobza M, Zinszner J, Blard JM, Pages M, Salvaing P - Hématomes spontanés du cervelet. Rev Neurol (Paris) 139: 193, 1983.
9. Little JR, Tubman DE, Ethier R - Cerebelar hemorrhage in adults: diagnosis by computerized tomography. J Neurosurg 48: 575, 1978.
10. Martí-Vilalta JD, Peiró A, Roig C - Transtornos oculomotores en la patología vascular aguda del cerebelo: estúdio clínico en 25 enfermos. Med Clin (Barcelona) 81: 603, 1983.
11. Mc Kissock W, Richardson A, Walsh L - Spontaneous cerebellar hemorrhage: a study of 34 consecutice cases treated surgically. Brain 83: 1, 1960.
12. Melamed N, Satya-Murti S - Cerebellar hemorrhage: a review and reapraisal of benign cases. Arch Neurol 41: 425, 1984.
13. Galera R, Greitz T - Hydrocefalus in the adult secondary to the rupture of intracranial arterial aneurysm. J Neurosurg 32: 634, 1970.
14. Ott KN, Kase CS, Ojeman RG, Mohr JP - Cerebellar hemorrhage diagnosis and treatment: a review of 56 cases. Arch Neurol 31: 160, 1974.
15. Ricart C, Soler L, Pou A - Hematomas cerebelosos: a propósito de 12 casos. Rev Clin Esp 5: 23, 1986.
16. Seeling JM, Selhorst JB, Young HF, Lipper M - Ventriculostomy for hydrocephalus in cerebelar hemorrhage. Neurology 31: 537, 1981.
17. Shenkin HA & Zavala M - Cerebellar strokes: mortality, surgical indications and results of ventricular drainage. Lancet 2: 429, 1982.
18. Yhosida S, Sasaki M, Oka A, Gotoh O, Yamada R, Sano K - Acute hypertensive cerebellar hemorrhage with signs of lower brainstem compression. Surg Neurol 10: 79, 1978.
19. Zieger A, Vonofakos D, Steudel WI, Dusterbehn G - Nontraumatic intracerebelar hematomas: prognostic value of volumetric evaluation by computed tomography. Surg Neurol 22: 491, 1984.

Hematoma cerebelar espontâneo: análise de 23 casos

Spontaneous cerebellar hematoma: analysis of 23 cases

Datas de Publicação

Publicação nesta coleção
22 Jun 2011
Data do Fascículo
Mar 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Brewer DB, Fawcet FJ, Horsfield GI - A necropsy series of cerebral hemorrhage with particular reference to heart weight. J Path Bact 96: 311, 1968.

[2] 2. Canales M, Garibi J, Uriguen M, Diaz-Aramendi A - Hemorragia cerebelosa espontánea. Rev Neurol (Barcelona) 9: 301, 1984.

[3] 3. Chin D, Carney P - Acute cerebelar hemorrhage with brainsten compression in contrast with benign cerebelar hemorrhage. Surg Neurol 19: 406, 1983.

[4] 4. Forgeau Y, Mussini JM, Ponge T, Bricout H - Les hématomes spontanés primitifs du cervelet. Arch Anat Cytol Path 32: 173, 1984.

[5] 5. Freeman RE, Onofrio BM, Okazaki A, Dinapoli RP - Spontaneous intracerebelar hemorrhage: diagnosis and surgical treatment. Neurology 23: 84, 1973.

[6] 6. Furlan AJ, Whisnant JP, Elverack LR - The decreasing incidence of primary intracerebelar hemorrhage. Ann Neurol 5: 367, 1979.

[7] 7. Jennett B, Bond M - Assessment of outcome after severe brain damage. Lancet 1: 480, 1975.

[8] 8. Labauge R, Boukobza M, Zinszner J, Blard JM, Pages M, Salvaing P - Hématomes spontanés du cervelet. Rev Neurol (Paris) 139: 193, 1983.

[9] 9. Little JR, Tubman DE, Ethier R - Cerebelar hemorrhage in adults: diagnosis by computerized tomography. J Neurosurg 48: 575, 1978.

[10] 10. Martí-Vilalta JD, Peiró A, Roig C - Transtornos oculomotores en la patología vascular aguda del cerebelo: estúdio clínico en 25 enfermos. Med Clin (Barcelona) 81: 603, 1983.

[11] 11. Mc Kissock W, Richardson A, Walsh L - Spontaneous cerebellar hemorrhage: a study of 34 consecutice cases treated surgically. Brain 83: 1, 1960.

[12] 12. Melamed N, Satya-Murti S - Cerebellar hemorrhage: a review and reapraisal of benign cases. Arch Neurol 41: 425, 1984.

[13] 13. Galera R, Greitz T - Hydrocefalus in the adult secondary to the rupture of intracranial arterial aneurysm. J Neurosurg 32: 634, 1970.

[14] 14. Ott KN, Kase CS, Ojeman RG, Mohr JP - Cerebellar hemorrhage diagnosis and treatment: a review of 56 cases. Arch Neurol 31: 160, 1974.

[15] 15. Ricart C, Soler L, Pou A - Hematomas cerebelosos: a propósito de 12 casos. Rev Clin Esp 5: 23, 1986.

[16] 16. Seeling JM, Selhorst JB, Young HF, Lipper M - Ventriculostomy for hydrocephalus in cerebelar hemorrhage. Neurology 31: 537, 1981.

[17] 17. Shenkin HA & Zavala M - Cerebellar strokes: mortality, surgical indications and results of ventricular drainage. Lancet 2: 429, 1982.

[18] 18. Yhosida S, Sasaki M, Oka A, Gotoh O, Yamada R, Sano K - Acute hypertensive cerebellar hemorrhage with signs of lower brainstem compression. Surg Neurol 10: 79, 1978.

[19] 19. Zieger A, Vonofakos D, Steudel WI, Dusterbehn G - Nontraumatic intracerebelar hematomas: prognostic value of volumetric evaluation by computed tomography. Surg Neurol 22: 491, 1984.