SPACE-OCCUPYING CEREBELLAR INFARCTION

About 20% of cerebellar infarcts are space occupying. The expanding po sterior fossa mass causes direct brain stem compression, hydrocephalus by occlusion of the fourth ventricle, and sometimes upward transtento rial herniation. This results in secondary brain stem symptoms and an increasing disturbance of consciousness two to four days after the str oke. Coma, posturing, ataxic respiration may develop within 24 hours. So patients must be monitored in an intensive care unit. It seems evid ent now, that many patients with massive cerebellar infarction only su rvive by neurosurgical intervention. Decompressive suboccipital cranie ctomy with removal of infarcted tissue is the most propagated surgical procedure. Nevertheless, there is no general agreement about the opti mal timing and type of surgical intervention at present.