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Therapeutic Strategies in Space-Occupying Cerebellar Infarction Based on Clinical, Neuroradiological and Neurophysiological Data
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1993
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Hydrocephalus OccursCerebrovascular DiseaseBrainstem CompressionCerebral Vascular RegulationNeurovascular DiseaseStrokeTherapeutic StrategiesIntracranial PressureBrain InjuryNeurologyCerebrovascular InterventionNeuropathologyHealth SciencesRehabilitationCerebral Blood FlowSpace-occupying Cerebellar InfarctionNeurophysiological DataNeurophysiologyNeuroanatomySurgical DecompressionNeuroscienceCentral Nervous SystemMedicine
The study proposes that treatment of cerebellar infarction should be guided by disease severity, with awake or drowsy patients managed medically or with ventriculostomy if hydrocephalus develops, and an ongoing multicenter trial aims to confirm these recommendations. The study included 42 cerebellar infarction patients, 27 retrospectively and 15 prospectively under a fixed protocol. Clinical and neurophysiological assessments, including an adapted Heros classification and evoked potentials, reliably estimate disease severity, and the data show that decompressive surgery is significantly superior to ventriculostomy in comatose patients and is the optimal treatment for obtunded patients with occlusive hydrocephalus and brainstem compression.
This study presents 42 patients with cerebellar infarctions; 27 patients were studied retrospectively, 15 patients were studied prospectively according to a fixed protocol. Rating of the clinical status using an adapted classification schema according to Heros with additional neuroimaging and neurophysiological data was found to be a reliable tool to estimate the severity of the disease. Evoked potential studies are useful and reliable to monitor the clinical course and to estimate the severity of the disease (i.e. BAEP) or predict outcome (i.e. SSEP). Treatment should be determined by the severity of the disease, i.e. awake and drowsy patients can be treated either medically or with ventriculostomy, if hydrocephalus occurs. In comatose patients decompressive surgery is significantly superior to ventriculostomy (p < 0.05). The analysis of the preliminary data suggests surgical decompression of the posterior fossa as the optimum therapeutic regimen in obtunded patients presenting with occlusive hydrocephalus and signs of brainstem compression. An open multicenter trial in Austria and Germany is in progress to confirm the results of this pilot study.