Prognostic Factors in Spontaneous Cerebellar Hemorhage and Pontine Hemorrhage

Gu, Il Kwon; Cho, Soo Ho; Kim, Seong Ho; Bae, Jang Ho; Kim, Oh Lyong; Choi, Byung Yearn

Abstract

The author studied 62 consecutive patients with spontaneous cerebellar hemorrhage and 38 patients with spontaneous pontine hemorrhage, diagnosed by computerized tomography scanning from May 1983 to December 1994 and assessed the relationship of outcome of initial GCS score, CT findings, and treatment modality. In cerebellar hemorrhage, good outcome was achieved in patients with high initial GCS score(>13), small hematoma, patent quadrigeminal cistern, absent hydroceohalic change, and the location of the hemorrhage in the hemisphere. Although the size of hematoma was an impotant prognostic factor, it had no constant bearing on the level of consciousness, degree of quadrigeminal cistern obliteration, and outcome. Absence of quadrigeminal cistern obliteration predicted a good outcome whether the hematoma was evacuated or not, as long as obstructive hydrocephalus, if present, was relieved darly. However, partial obliteration of the quadrigeminal cistern was a predictor of good outcome if the hematoma was evacuate d within 48 hours after the onset of hemorrhage. Total obliteration of the quadrigeminal cistern inevitably predicted an unfavorable outcome. In pontine hemorrhages, a good outcome was achieved in patients with high initial GCS score(>13), small size hematoma(<5cc) and patent quadrigeminal cistern. Especially, the size of the hematoma was an important prognostic factor and guideline for the determination of surgical candidates. Small hematomas(<5cc) responded more positively to conservative management than to surgery. However, early hematoma evaculation(<48hr) had improved the outcome in moderate sized hematomas(5-10cc). Large hematomas(>10cc) inevitably showed an unfavorable outcome.