Pathophysiology and Treatment for Massive Cerebellar Infarction

Edematous swelling due to occlusion of the vertebrobasilar artery and its branches can produce a large cerebellar lesion that compresses the brain stem and rapidly lead to coma and death. To investigate the optimum therapy of cerebellar infarction, 139 patients with acute ischemic symptoms of the vertebrobasilar territory were studied. Computerized tomography was helpful in diagnosis and treatment of the patients. In 25 patients, cerebellar infarction was accompanied by obstructive hydrocephalus resulting from acute compression of the pathway of the cerebrospinal fluid. Although ventricular drainage was effective in some of them, immediate surgical decompression of the posterior fossa was needed to ensure not only life saving but also useful social activity, if the brain stem was not extensively involved. In the other patients without obstructive hydrocephalus, symptoms due to brain stem compression never developed even if the size of the infarction was large. It is concluded that development of obstructive hydrocephalus is a good indicator in selecting surgical treatment for patients with cerebellar infarction.