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1 Sang Mok Lee, M.D., Boo Jung, M.D., Kyu-Yong Lee, M.D., Young Joo Lee, M.D., Jin Hwan Cheong, M.D., Jae Min Kim, M.D. Departments of Neurology and Neurosurgery, Hanyang University College of Medicine, Seoul, Korea Background: Cerebellar hemorrhage may present with a wide spectrum of clinical manifestations, from a benign course with little to no neurological deficit to a rapidly fatal course with hydrocephalus and brainstem compression. However, controversy remains concerning the management of patients with cerebellar hemorrhage. The aim of this study was to set the criteria for conservative or surgical treatment and predictive factors of poor outcomes. Methods: During the 5-year period from July through July, a series of consecutive patients with spontaneous cerebellar hemorrhage was evaluated. On admission, all patients underwent a standard neurological examination, and a computed tomography (CT) scan. The location and size of hematoma, hypertension, hydrocephalus, intraventricular hemorrhage and compression of quadrigeminal cistern on a CT scan were compared with the Glasgow coma scale (GCS) and Glasgow Outcome Scale (GOS). Results: Patients with GCS scores of or more at admission and with a hematoma of less than 5 ml showed good outcomes. Patients with GCS scores of or less at admission or with a hematoma measuring 5 ml or more had poor outcomes. Patients with intraventricular hemorrhage (p.5), compression of quadrigeminal cistern (p.5), and hydrocephalus (p.5) in the brain CT had poor outcomes. Conclusions: In treating patients with spontaneous cerebellar hemorrhage, an initial GCS and CT scan were quite helpful in determining treatment strategies. For patients whose CT scan show intraventricular hemorrhages, compression of the quadrigeminal cistern, and hydrocephalus, intensive therapy should be deemed necessary. J Korean Neurol Assoc ():~, Key Words: Spontaneous cerebellar hemorrhage, Treatment strategy, Prognosis, Glasgow outcome scale 서론 대한신경과학회지 권 호

2 대상과방법 결과 Table. Summary of cases of spontaneous cerebellar hemorrhage Clinical findings Number (%) M:F Mean age Hypertension Symptom at the onset Headache Vomiting Vertigo Slurred speech Loss of consciousness Gait disturbance GCS at admission Hematoma sites Vermis Hemisphere Treatment modality Conservative Surgery Extraventicular drainage(evd) Craniectomy Craniectomy & EVD Outcome Good Poor Overall mortality GCS; Glasgow coma scale :. yr (-8 yr) 5 () () (8 (8) () () 8 () 8 (5) () () () () () 8 (5) () () () 권 호대한신경과학회지

3 Table. Statistical analysis of factors influencing outcome Age and GOS Hypertension and initial GCS Hypertension and GOS Hematoma site and initial GCS Hematoma site and GOS Table. CT findings compared with initial GCS and GOS CT findings Hydrocephalus Intraventricular hemorrhage Cisternal compression Initial GCS GOS Good Poor p value NS GCS; Glasgow coma scale, GOS; Glasgow outcome scale, NS; significance GCS; Glasgow coma scale, GOS; Glasgow outcome scale 고찰 Table. Initial GCS compared with GOS according to treatment mordality Initial GCS Conservative treatment Operation Good Poor Good Poor GCS; Glasgow coma scale, GOS; Glasgow outcome scale 8 Table 5. Hematoma volume compared with GOS according to treatment mordality Hematoma volume 5 ml 5- ml ml Conservative treatment Operation Good Poor Good Poor GOS; Glasgow outcome scale 대한신경과학회지 권 호

4 Figure. Management protocol for spontaneous cerebellar hemorrhage. GCS; Glasgow coma scale. 권 호대한신경과학회지

5 . Rho JK, Park SH. A study on Cerebellar hemorrhage. J Korean Neurol Assoc 8;:-8.. Rey-Bellet J. Cerebellar hemorrhage. A clinicopathologic study. Neurology ;:-.. Dinsdale HB. Spontaneous hemorrhage in the posterior fossa. A study of primary cerebellar and pontine hemorrhage with observation on their pathogenesis. Arch Neurol ;: -.. van der Hoop RG, Vermeulen M, van Gijn J. Cerebellar hemorrhage: diagnosis and treatment. Surg Neurol 88; :-. 5. Kim MH, Yoon BW, Roh JK. Prognosis of cerebellar Hemorrhage; comparing hypertensive and normotensive group. J Korean Neurol Assoc ;; Kobayashi S, Sato A, Kageyama Y, Nakamura H, Watanabe Y, Yamaura A. Treatment of hypertensive cerebellar hemorrhage-surgical or conservative management. Neurosurgery ;:-5.. Lui TN, Fairholm DJ, Shu TF, Chang CN, Lee ST, Chen HR. Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 85;: Mezzadri JJ, Otero JM, Ottino CA. Management of 5 spontaneous cerebellar haemorrhages. Acta Neurochir ; :-.. Ott KH, Kase CS, Ojemann RG, Mohr JP. Cerebellar hemorrhage: diagnosis and treatment. A review of 5 cases. Arch Neurol ;:-.. Brennan RW, Bergland RM. Acute cerebellar hemorrhage. Analysis and clinical findings and outcome in cases. Neurology ;:5-5.. McKissock W, Richardson A, Walsh L. Spontaneous cerebellar haemorrhage. A study of cases treated surgically. Brain ;8:-.. Vassilouthis J, Richardson AE. Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg ;5:-5.. Taneda M, Hayakawa T, Mogami H. Primary cerebellar hemorrhage. Quadrigeminal cistern obliteration on CT scans as a predictor of outcome. J Neurosurg 8;: Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 5;: Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir ;: Melamed N, Satya-Murti S. Cerebellar hemorrhage. A review and reappraisal of benign cases. Arch Neurol 8; :5-8.. Lui TN, Fairholm DJ, Shu TF, Chang CN, Lee ST, Chen HR. Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 85;: Pollak L, Rabey JM, Gur R, Schiffer J. Indication to surgical management of cerebellar hemorrhage. Clin Neurol Neurosurg 8;:-.. Little JR, Tubman DE, Ethier R. Cerebellar hemorrhage in adults. Diagnosis by computerized tomography. J Neurosurg 8;8: Waidhauser E, Hamburger C, Marguth F. Neurosurgical management of cerebellar hemorrhage. Neurosurg Rev ;:-. 대한신경과학회지 권 호

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical