Cerebellar stroke

Learning objectives

Link to RCP Stroke Guidelines 2016

• Acute stroke services should have protocols for the monitoring, referral and transfer of patients to regional neurosurgical centres for decompressive hemicraniectomy, surgical management of intracranial haemorrhage and the management of symptomatic hydrocephalus including external ventricular drain insertion

AHA [USA] Guidelines

• Ventriculostomy is recommended in the treatment of obstructive hydrocephalus after a cerebellar infarct. Concomitant or subsequent decompressive craniectomy may or may not be necessary on the basis of factors such as infarct size, neurological condition, degree of brainstem compression, and effectiveness of medical management.
• Decompressive suboccipital craniectomy with dural expansion should be performed in patients with cerebellar infarction causing neurological deterioration from brainstem compression despite maximal medical therapy. When deemed safe and indicated, obstructive hydrocephalus should be treated concurrently with ventriculostomy.
• When considering decompressive suboccipital craniectomy for cerebellar infarction, it may be reasonable to inform family members that the outcome after cerebellar infarct can be good after sub-occipital craniectomy.