Background: Identifying patients with cerebellar haemorrhages who are at highest risk of deterioration is a major clinical challenge. We aimed to compare patients with cerebellar haemorrhage who deteriorated compared to those who did not to determine potential risk factors.
Methods: A retrospective analysis of a prospectively collected database of patients at a tertiary stroke centre with cerebellar haemorrhages between 2020-2022 was completed. Demographics and outcomes with deterioration defined as inpatient death or requirement for surgery were recorded. Imaging data was assessed by 2 clinicians, using the ABC/2 formula to assess haemorrhage volume. Ordinal data were compared with Fisher’s exact, and continuous variables with Wilcoxon rank-sum.
Results: A total of 39 patients (median age 72 (64-78), 53.85% female) were included. Of these, 51.28% deteriorated. Baseline demographics were well matched between groups. Median baseline Glasgow Coma Scale (GCS) (14 vs 15, p=0.03), median GCS nadir (8 vs 15, p=0.0001) and change from baseline (2.5 vs 0, p=0.0001) were worse in the deteriorated group. Imaging features of hydrocephalus (65% vs 10.53%, p=<0.0001), 4th ventricular effacement (90% vs 57.89%, p=0.031), and herniation (35% vs 5.26%, p=0.044) were more frequent in the deterioration group, alongside a higher median ICH volume (18.46ml vs 6.72ml, p=0.0005). A cut-off ICH volume of 15.4mL was associated with deterioration with sensitivity of 0.75 and specificity 0.8, with ROC area under the curve of 0.8.
Conclusion: Higher baseline haemorrhage volume, with a proposed cut-off of 15.4mL, and imaging features of hydrocephalus, 4th ventricular effacement and herniation were associated with clinical deterioration.