TREATMENT OF HYPERTENSIVE CEREBELLAR HEMORRHAGE - SURGICAL OR CONSERVATIVE MANAGEMENT

ONE HUNDRED AND one consecutive patients with hypertensive cerebellar hemorrhage were analyzed to determine the criteria for surgery. New cr iteria based on the patient's Glasgow Coma Scale score at admission an d the maximum diameter of the hematoma, as disclosed by computed tomog raphy, are proposed from a retrospective analysis of 52 earlier cases. The criteria are as follows: 1) patients with Glasgow Coma Scale scor es of 14 or 15 and with a hematoma of less than 40 mm in maximum diame ter are treated conservatively; 2) for the patients with Glasgow Coma Scale scores of 13 or less at admission or with a hematoma measuring 4 0 mm or more, hematoma evacuation with decompressive suboccipital cran iectomy should be a treatment of choice; and 3) for the patient whose brain stem reflexes are entirely lost with flaccid tetraplegia or whos e general condition is poor, intensive therapy is not indicated. The v alidity of these criteria was tested and confirmed in 49 recent cases.