What's the diagnosis? By Dr. Loran Hatch
An 81 yo female presents with acute onset AMS approximately one hour ago. No known history of trauma. Pt reports she doesn't feel well and wants to be left alone to sleep. She is oriented x3 with very poor effort on neuro exam. She moves all extremities and has no facial droop and no pronator drift. Per EMR pt takes warfarin for hx of a-fib. CT head is shown below. What's the diagnosis? Scroll down for answer.
Answer: Cerebellar Hemorrhage
Risk factors: HTN, older age, anticoagulation, excessive ETOH
Symptoms: dizziness/vertigo, nausea and vomiting, gait instability, headache, limb ataxia, dysarthria, nystagmus, and cranial nerve abnormalities
- BP management - goal <180 SBP; no advantage for aggressive BP lowering per INTERACT-2 trial (click here for quick reference on BP managment of neurological emergencies)
- Surgical decompression ASAP (>3cm, neurological deterioration, brainstem compression, hydrocephalus)
- Reversal of anticoagulation (warfarin - vitamin K and PCC favored over FFP (PCC requires less volume and evidence suggests it is faster)
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Rordorf G, McDonald C. ‘Spontaneous intracerebral hemorrhage: Treatment and prognosis.” UpToDate, Inc. Nov 2018
Rordorf G, McDonald C. “Spontaneous intracerebral hemorrhage: Pathogenesis, clinical features, and diagnosis.” UpToDate, Inc. Nov 2018