Abstract
A 38-year-old female with delayed development of a traumatic intracerebellar hematoma which was demonstrated on serial CT scans, associated with a supratentorial cerebral contusion was reported. The patient fell and struck the occiput. She became confused and agitated, with mild anisocoria (R>L) and peripheral paralysis of the right facial nerve. Swelling and laceration were present over the right occiput. There was bloody cerebrospinal otorrhea on the right. X-ray films of the skull revealed a right temporo-occipital linear fracture, a right occipital linear fracture extending across the transverse sinus and separation of the right lambdoid suture. An initial CT scan showed a faint high density area in the cerebellar vermis suggesting a hemorrhage in addition to cerebral contusion of the right temporal lobe and a tentorial injury. The level of consciousness progressively improved within several hours with treatment including corticosteroid and hypertonic solution. CT scans performed 36 hours following the injury revealed a newly formed hematoma in the right cerebellar hemisphere and enlarged hemorrhagic foci in the right temporal lobe with perifocal edema. Ten days after the injury, she gradually became semicomatose. Marked anisocoria and bilateral spasticity followed by respiratory arrest developed when a perifocal low density area around the intracerebellar hematoma was demonstrated by CT scans. Emergency posterior fossa craniectomy was then performed. On opening of the dura mater which showed a 2 cm long laceration 20 ml of solid hematoma was extruded from an underlying cortical laceration. Debridement of the contused cerebellar hemisphere was also performed. On the first postoperative day, the level of consciousness progressively improved. However, she became semicomatose again on the second postoperative day. A postoperative CT scan performed on the second day revealed marked swelling of the cerebellum in addition to supratentorial brain edema at the site of the cerebral contusion. Despite intensive management with hypertonic solutions she died of secondary brain stem compression due to the cerebellar swelling on the 6th postoperative day. The present case suggested that a contusional hematoma of the cerebellum should be removed as soon as possible when it shows a mass effect in CT scans even if clinical signs and symptoms show improvement.
