Abstract
We studied ten cerebellar arteriovenous malformation (AVM) patients presenting with severe impairment of consciousness, in regard to the relationship between the clinical courses, imaging studies and surgical results. The preoperative level of consciousness was 200-300 (JCS). All patients showed respiratory abnormalities due to tonsillar herniation. In all patients, CT scans revealed a large hematoma at least 3 cm in diameter, but the AVM proved on operation or on angiography to be small. According to the Glasgow outcome scale, surgery was followed by good recovery (GR) in two patients, moderate disability (MD) in two, severe disability (SD) in two, a vegetative state (V) in one, and death (D) in three. The pupils of the six patients who underwent a relatively favorable recovery (2GR, 2MD, 2SD) exhibited miosis or reaction to light, whereas the pupils of the other four patients showed no light reflex. The intervals between onset and the clinical manifestation of tonsillar herniation were longer in the patients showing GR, MD, or SD than in those in whom V or D followed. There was no relationship between the surgical results and age at onset, interval from onset to admission, interval from admission to operation or size of hematoma. In our series, 40% of the poor risk patients recovered enough to require no assistance in their daily lives. We concluded that urgent surgical intervention is essential in cases of cerebellar hemorrhage caused by AVM, in which the pupils are not fully dilated and are responsive to light, even if there has been an episode of respiratory arrest in a deep comatous state.
