Cerebellar Hemorrhage (Haemorrhage)

The cerebellum is in a restricted space (called the posterior fossa of the skull (both diagrams below courtesy of Bartleby.com, creative commons license).

The increase in size caused by the volume of blood can rapidly cause a build up of pressure in the head.

Critical structures will rapidly become compressed, causing loss of consciousness and coma. If the flow of cerebrospinal fluid is blocked by pressure on the fourth ventricle (which sits in front of the cerebellum) acute hydrocephalus can occur.

The condition is often fatal (9/22 in one European series).

Thunderclap Headache is said to be a presentation of this type of stroke.

However, to present with just acute severe, maximal at onset headache and headache alone is rare. It is almost certain that other neurological symptoms would occur.

Most cerebellar haemorrhages are due to hypertension, and some are due to arterial malformations or haemorrhagic brain tumors.

Diagnosis is obvious on CT Brain scan, so a normal scan will exclude this diagnosis with a high level of certainty.

As almost everyone who reaches hospital with a thunderclap headache should have a CT Brain this is a diagnosis that is hard to overlook.

References

van der Hoop RG, Cerebellar haemorrhage: diagnosis and treatment.Surgical Neurology 1988 Jan;29:6-10. (series of 22 cases) (Free Abstract only)

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