Abstract
A series of 26 patients with cerebellar infarction were classified into 4 groups based on clinical and CT findings. Four comatose patients of these cases with cerebellar infarction (Group III) who were successfully treated with external ventricular drainage (EVD) alone, are presented. These 4 patients, who developed vertigo, nausea or vomiting, fell into a coma in 32 to 72 hours after the onset of their symptoms and were referred to our department of neurosurgery.
Computed tomography (CT) revealed swelling of the infarcted cerebellum and acute hydrocephalus, and therefore an EVD tube was inserted in place. Continuous postoperative monitoring of intracranial pressure (ICP) demonstrated EVD had sufficient control of ICP and therefore suboccipital decompression of the cerebellum was not indicated. All 4 cases made a gradual recovery. Three patients, independently ambulatory, were discharged to their home and 1 patient, ambulatory with assistance, was discharged to a rehabilitation hospital.
The results of our cases suggest that EVD should first be performed in the cases of cerebellar infarction with cerebellar swelling or edema accompanied by hydrocephalus. Posterior fossa decompression and removal of infarcted cerebellar tissue should be indicated only in cases where ICP cannot be controlled by EVD, even if there is no immediate recovery of the patient's impaired consciousness. Reviewing the literature pertinent to our cases, we discuss the use of ventricular drainage alone in the management of cerebellar infarction with ischemic cerebellar swelling.
