【Case Sharing】Cerebellar old hematoma

【Case Information】

The patient, female, 25 years old, was admitted to the hospital

During the treatment, the patient's symptoms have improved, but after 14 days of treatment, the patient's symptoms such as headache, nausea, and vomiting are still repeatedly aggravated, and the head CT pan + enhancement shows that the hematoma is slightly reduced, the edema in the bleeding area is slightly increased, and the enhancement is seen in the ring around the high-density shadow, so the hematoma removal is performed

【Discussion】

The incidence of old cerebellar hematoma is low, often occurs several weeks after cerebellar hemorrhage, and the formation mechanism is unclear

The old cerebellar hematoma is different, and its characteristics are summarized in combination with this example as follows:

(1) Formed after several weeks of cerebellar hemorrhage;

(2) The duration of the course of the disease can be as long as several months, and if there is no surgery, the course of the disease may last for several years;

(3) Clinical manifestations often include symptoms such as dizziness, headache, nausea, vomiting, and cerebellar damage signs such as ataxia;

(4) The effect of conservative treatment is poor, and the disease is prone to recurrence;

(5) CT shows that the absorption of hematoma is extremely slow, usually conservative treatment for 1 to 2 months, no obvious absorption and reduction of hematoma has been seen, the surrounding edema subsides slowly, and the ring reinforcement band may appear when the enhancement occurs, and the hematoma may also form softening lesions and even calcifications in the long term;

(6) Surgery and disease examination often see complete fibrosis enveloped hematoma (this fibrotic envelope may form a barrier effect with brain tissue, making the hematoma not easy to absorb), organized blood clots can be seen in the envelope, and hematoma calcification can be seen in longer periods

The disease is often differentiated from cerebellar tumors and cavernous hemangiomas for bleeding:

(1) Cerebellar tumor bleeding, general disease development is abrupt, nerve symptoms are heavy, peripheral edema is obvious, enhanced MRI can find tumor lesions, postoperative disease examination can find tumor cells;

(2) Cavernous hemangioma bleeding can be manifested as repeated bleeding of hemangioma, resulting in edema around the brain tissue that does not recede easily, and repeated bleeding MRI can also be manifested as T1WI high signal and T2WI low signal