St. Louis et al identified factors associated with a poor outcome for a patient with a spontaneous cerebellar hematoma. This can help identify patients who may benefit from more aggressive management and monitoring. The authors are from the Mayo Clinic.
Patient selection: A patient was excluded if there was an underlying cause for the hematoma.
Poor outcome was defined as on of the following at 3 or more months after admission:
(1) physical disability (long-term care facility)
(2) death
Risk factors associated with a poor outcome:
(1) systolic blood pressure on admission > 200 mm Hg
(2) hematoma measuring > 3.0 cm in maximum dimension
(3) visible distortion of the brain stem on imaging studies
(4) acute hydrocephalus
Risk factors associated with subsequent death:
(1) abnormal corneal and oculocephalic (doll's eye) responses
(2) Glasgow coma score (GCS) < 8
(3) motor response less than localization to pain (withdrawal, flexion, extension or no response)
(4) acute hydrocephalus
(5) intraventricular hemorrhage
Classification and Regression Tree (CART) analysis was based on:
(1) cornea reflex
(2) hydrocephalus
(3) doll's eyes (oculocephalic response)
(4) age
(5) size of the hematoma in cm
|
Cornea Reflex |
Hydro-cephalus |
Doll's Eyes |
Age |
Size in cm |
Poor Outcome |
|
absent |
NA |
NA |
NA |
NA |
86% |
|
present |
present |
present |
NA |
NA |
46% |
|
present |
present |
absent |
NA |
NA |
92% |
|
present |
absent |
NA |
>= 70 |
> 3 cm |
53% |
|
present |
absent |
NA |
>= 70 |
<= 3 cm |
27% |
|
present |
absent |
NA |
< 70 |
NA |
15% |
Specialty: Neurology
