CT Case 078
An 82-year-old female of Asian descent from a nursing home presents with hypertension, nausea and vomiting.
Vitals are BP 180/105, HR 65, GCS 8, which soon dropped to 6.
Past medical history: atrial fibrillation on warfarin
Soon after arrival, warfarin was reversed due to suspicion of intracranial haemorrhage and the patient was sent for urgent CT scan.
Describe and interpret her non-contrast CT scan
There is a large intra-parenchymal haemorrhage located in the medial right cerebellar hemisphere extending into the cerebellar vermis.
There is intraventricular extension into the fourth ventricle and aqueduct with mild obstructive hydrocephalus (mild dilatation of the lateral ventricles).
Clinical Pearls
Cerebellar haemorrhage comprise approximately 10% of all intracerebral haemorrhages (ICH).
Typical clinical symptoms are vertigo, ataxia, headache and vomiting. If they progress in size reduced consciousness will follow.
Cerebellar haemorrhage may be related to hypertension, trauma, coagulopathy, haemorrhagic transformation of ischaemic strokes, as well as underlying vascular abnormalities such as AVMs.
Incidence increases with age and is most prevalent in Asian populations, as in our patient.
Cerebellar bleeds are a neurosurgical emergency with urgent referral required due to the risk of mass effect and brain stem compression, cerebellar herniation and resultant hydrocephalus.
This bleed was deemed nonsurvivable and the patient was managed on a palliative pathway.
Amazingly, the next day she made a neurological recovery, she was obeying commands and ultimately returned to her nursing home.
References
- Fischer MA, Das JM. Cerebellar Hematoma. StatPearls
- Witsch J, Neugebauer H, Zweckberger K, Jüttler E. Primary cerebellar haemorrhage: complications, treatment and outcome. Clin Neurol Neurosurg. 2013 Jul;115(7):863-9.
TOP 100 CT SERIES
Provisional fellow in emergency radiology, Liverpool hospital, Sydney. Other areas of interest include paediatric and cardiac imaging.
Emergency Medicine Education Fellow at Liverpool Hospital NSW. MBBS (Hons) Monash University. Interests in indigenous health and medical education. When not in the emergency department, can most likely be found running up some mountain training for the next ultramarathon.
Dr Leon Lam FRANZCR MBBS BSci(Med). Clinical Radiologist and Senior Staff Specialist at Liverpool Hospital, Sydney
Sydney-based Emergency Physician (MBBS, FACEM) working at Liverpool Hospital. Passionate about education, trainees and travel. Special interests include radiology, orthopaedics and trauma. Creator of the Sydney Emergency XRay interpretation day (SEXI).