Cerebellar hemorrhage

Cerebellar hemorrhage is a form of intracranial hemorrhage and is most frequently seen in the setting of poorly controlled hypertension, although this can of course also be secondary to an underlying lesion (e.g. tumor or vascular malformation) or due to supratentorial surgery (see remote cerebellar hemorrhage).

This article concerns itself with primary cerebellar hemorrhages.

The demographics of affected patients reflect those of patients with long term poorly controlled hypertension, and as such patients are usually elderly.

Cerebellar hemorrhages only account for approximately 10% of all intracerebral hemorrhages 3.

Clinical presentation depends on the size and speed of enlargement of the hemorrhage. Unlike pontine hemorrhages which are usually obvious to both the clinician and the patient, cerebellar hemorrhages, if small enough, can present relatively subtly. Cerebellar signs (e.g. ataxia, nystagmus) 1. Larger bleeds can impair consciousness and obstruct the fourth ventricle resulting in obstructive hydrocephalus.

As with other hemorrhagic strokes, CT is usually the first, and often the only imaging investigation obtained.

As with other acute hemorrhages, cerebellar hemorrhages appear as regions of hyperdensity within the cerebellar hemispheres. Extension into the fourth ventricle or subarachnoid space is relatively common.

Unlike pontine hemorrhages, cerebellar hemorrhages carry a relatively good prognosis if timely evacuation and control of hydrocephalus can be obtained.

Prompt diagnosis and neurosurgical referral are therefore key. Typically if a hemorrhage causes brainstem compression or is greater than 3 cm in diameter (20-30 mL) then evacuation is beneficial 2.

Stroke and intracranial haemorrhage
Share article

Article information

rID: 13412
Synonyms or Alternate Spellings:
  • Cerebellar hemorrhage
  • Cerebellar bleed
  • Cerebellar haemorrhages
  • Cerebellar hemorrhages
  • Cerebellar bleeds

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Case 5
    Drag here to reorder.
  • Case 6
    Drag here to reorder.
  • Case 7
    Drag here to reorder.
  • Case 8: with intraventricular extension and obstructive hydrocephalus
    Drag here to reorder.
  • Case 9
    Drag here to reorder.
  • Case 10
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.