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Findings: Noncontrast CT scan of the brain demonstrates a 2 cm hemorrhage within the vermis. There is no associated mass effect or hydrocephalus.
Diagnosis: 2 cm. vermian hematoma.
Discussion: Cerebellar hemorrhage has a frequency of less than 5%. This usually afflicts males around the age of 65. Clinical symptoms include posteriorly located headaches, dysarthria and ataxia. Delayed alteration of consciousness is seen in 90% of the cases with mass effect, which may vary from a few hours to up to ten days.
Cerebellar hemorrhage is often difficult to diagnose secondary to the extensive beam hardening artifact and volume averaging seen within the posterior fossa. If a cerebellar hemorrhage is seen or is associated with high clinical suspicion, it is important to check for asymmetry of the 4th ventricle as well as check for enlargement of the temporal horn, which is a sign of early obstructive hydrocephalus. Particular attention should be made to the superior vermis for herniation of through the tentorial incisura or to the cerebellar tonsils and inferior vermis for herniation through the foramen magnum.
References:
Grossman J, Yoursen PU. Neuroradiology, The Requisites.
Mosby, St. Louis; 1994:313-315.
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