Treatment of Cerebellar Intracerebral Hemorrhage with Neurological Deterioration, Brainstem Compression, or Large Hemorrhage Volume

Cerebellar intracerebral hemorrhage (ICH) presenting with certain high-risk features defines a specific clinical sub-population that requires immediate, protocol-driven management distinct from supratentorial ICH.

This Protocol Applies When

Neurological deterioration is present
Brainstem compression is identified
Hydrocephalus from ventricular obstruction is present
Cerebellar hemorrhage volume is 15 mL or greater

Treatment Approach

In this clinical scenario, a surgical approach is preferred over medical management alone. The complete protocol specifies the precise surgical strategy, the adjunctive measures that may accompany it, and the clinical indications that determine each component.

Full procedural details and decision thresholds are in the structured regimen below.

Instant Access to Structured Evidence-Based Regimens

References

For patients with cerebellar ICH who are deteriorating neurologically, have brainstem compression and/or hydrocephalus from ventricular obstruction, or have cerebellar ICH volume ≥15 mL, immediate surgical removal of the hemorrhage with or without EVD is recommended in preference to medical management alone to reduce mortality.

DOI: 10.1161/STR.0000000000000407

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