cerebellar_infarction_treatment

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cerebellar_infarction_treatment [2021/08/03 11:39]
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cerebellar_infarction_treatment [2021/08/03 11:40] (current)
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 Cerebellar strokes after day one develop progressive edema and subsequent herniation. So, it is very important to admit these patients to ICU and monitor them very closely. The earliest symptoms are severe headache, altered mental status, vomiting, and drowsiness. Large strokes with significant cerebral edema, especially if the intracranial pressure is elevated, often require extraventricular drains, ventriculostomy, or decompressive sub-occipital craniotomy. Neurosurgical removal of infarcted tissue or hematoma is also occasionally necessary. In these cases, rapidly reversible agents such as intravenous heparin should be used. In the acute setting, mannitol, hypertonic saline, or hyperventilation can also be helpful to temporarily reduce intracranial pressure Cerebellar strokes after day one develop progressive edema and subsequent herniation. So, it is very important to admit these patients to ICU and monitor them very closely. The earliest symptoms are severe headache, altered mental status, vomiting, and drowsiness. Large strokes with significant cerebral edema, especially if the intracranial pressure is elevated, often require extraventricular drains, ventriculostomy, or decompressive sub-occipital craniotomy. Neurosurgical removal of infarcted tissue or hematoma is also occasionally necessary. In these cases, rapidly reversible agents such as intravenous heparin should be used. In the acute setting, mannitol, hypertonic saline, or hyperventilation can also be helpful to temporarily reduce intracranial pressure
-((Ioannides K, Tadi P, Naqvi IA. Cerebellar Infarct. 2021 Jul 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29261863.))+((Ioannides K, Tadi P, Naqvi IA. Cerebellar Infarct. 2021 Jul 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29261863.)).
  
-===== Surgical indications =====+===== Cerebellar infarction Surgery =====
  
-Surgical decompression should probably be done as soon as any of the following signs develop if there is no response to medical therapy.+see [[Cerebellar infarction Surgery]].
  
-It is important to recognize a [[lateral medullary syndrome]] (LMS) which may often accompany a [[cerebellar infarct]]. With LMS, the signs are usually present from the onset (dysphagia, dysarthria, Horner syndrome, ipsilateral facial numbness, crossed sensory loss...), and are not accompanied by a change in sensorium. There is no place for surgical decompression in LMS since it represents primary brainstem ischemia and not compression. 
  
-Findings proceed in the approximate following sequence if there is no intervention:  
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-1. abducens (VI) nerve palsy 
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-2. loss of ipsilateral gaze (compression of VI nucleus and lateral gaze center) 
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-3. peripheral facial nerve paresis (compression of facial colliculus) 
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-4. confusion and somnolence (may be partly due to developing hydrocephalus) 
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-5. Babinski sign 
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-6. hemiparesis 
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-7. lethargy 
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-8. small but reactive pupils 
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-9. coma 
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-10. posturing→flaccidity 
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-11. ataxic respirations 
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-In an institution experience for patients with worsening levels of consciousness and radiologically evident ventricular enlargement, they recommend external ventricular drainage, and reserve surgical resection of necrotic tissue for patients whose clinical status worsens despite ventriculostomy, those for whom worsening is accompanied by signs of brainstem compression, and those with tight posterior fossae 
-((Raco A, Caroli E, Isidori A, Salvati M. Management of acute cerebellar 
-infarction: one institution's experience. Neurosurgery. 2003 Nov;53(5):1061-5; 
-discussion 1065-6. PubMed PMID: 14580272. 
-)). 
- 
-===== Suboccipital Decompressive Craniectomy for Cerebellar Infarction ===== 
-[[Suboccipital Decompressive Craniectomy for Cerebellar Infarction]] 
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- 
- 
-===== References ===== 
  
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  • by administrador