A cerebellar hematoma involving the vermis or larger than 3cm carries a bad prognosis, as does associated hydrocephalus. Hematomas over 2-3cm in size or those causing brainstem compression or decreased sensorium should be surgically evacuated. Smaller hematomas under 2cm or those with stable neurological status can be managed conservatively if closely monitored for signs of hydrocephalus. Guidelines associate poor outcomes with decreased consciousness, hematoma volumes over 40ml, midline shift, intraventricular hemorrhage over 20ml, age over 65, limb plegia, early hyperglycemia, or early fever.

1. Cerebellar hematomaCerebellar hematoma
DR Asit BeheraDR Asit Behera
Consultant critical care unitConsultant critical care unit
Ashwini HospitalAshwini Hospital

2. Bad prognosis associated with cerebellarBad prognosis associated with cerebellar
hematomahematoma
-- vermis-- vermis
-- >3cm-- >3cm
-- Hydrocephalus.-- Hydrocephalus.

3. Surgical indicationSurgical indication
 Sign of brainstem compression or decreased inSign of brainstem compression or decreased in
sensoriumsensorium
 Moderate to large size, 2-3cm hematoma shouldModerate to large size, 2-3cm hematoma should
be operated before deteriorationbe operated before deterioration
 <2 cm or small may be managed conservatively<2 cm or small may be managed conservatively
till the early sign of hydrocephalus.till the early sign of hydrocephalus.

4. Conservative managementConservative management
 Small <2cm hematoma with stable neurologicalSmall <2cm hematoma with stable neurological
status.status.
 Cerebellar hematoma with unimpairedCerebellar hematoma with unimpaired
consciousness and stable neurological courseconsciousness and stable neurological course
seen after 1 week.seen after 1 week.

5. Existing guidelines associated withExisting guidelines associated with
poor outcomepoor outcome
 Decreased level of consciousnessDecreased level of consciousness
 >40ml>40ml
 Midline shiftMidline shift
 IVH of vol >20mlIVH of vol >20ml
 >65yrs>65yrs
 Limb plegiaLimb plegia
 Early hyperglycemiaEarly hyperglycemia
 Early fever.Early fever.

6. Existing guidelines associated withExisting guidelines associated with
poor outcomepoor outcome
 Decreased level of consciousnessDecreased level of consciousness
 >40ml>40ml
 Midline shiftMidline shift
 IVH of vol >20mlIVH of vol >20ml
 >65yrs>65yrs
 Limb plegiaLimb plegia
 Early hyperglycemiaEarly hyperglycemia
 Early fever.Early fever.