Cerebellar Hematoma

Cerebellar hemorrhage or hematoma is a type of intracranial hemorrhage (ICH) where the bleeding is located in the posterior fossa or cerebellum and accounts for 9% to 10% of all ICH. The posterior fossa is a small space in the skull containing the brainstem and cerebellum. If a mass such as a hemorrhage grows in this region, particularly the brainstem and 4th ventricle, it can block the normal flow of cerebral spinal fluid leading to hydrocephalus, increased intracranial pressure, and symptoms onset. Cerebellar hemorrhage can be spontaneous, a result of a stroke or secondary to trauma, and occurs most frequently in middle-aged and older adults. Patients typically have underlying risk factors leading to hemorrhages such as hypertension or small vessel disease. The clinical presentation is dependent upon the size and location of the hematoma as well as the location and amount of edema of associated structures in the posterior fossa. The initial imaging modality is typically a non-contrast computed tomography (CT) scan. Management spans the spectrum from close observation to acute surgical intervention with optimal timing of surgery.