Emergency Department Management of Cerebellar Hemorrhage

• Patients with cerebellar hemorrhage are at risk for an abrupt and dramatic deterioration to coma within the first 24hrs; Emergency providers should be prepared to intubate if necessary.
• Cerebellar hemorrhages >3cm in diameter with concurrent brainstem compression, or develop hydrocephalus have better outcomes with surgical decompression. Consider early transfer to a facility capable of providing immediate neurosurgical intervention.
• Extra-ventricular drain (EVD) placement may be a temporizing measure if hydrocephalus is present. However, management with an EVD alone is insufficient and may be harmful.
• The INTERACT II trial has shown better functional outcomes with rapid (within 1hr) reduction of BP. Patients with BP of 150-220 should be lowered to a goal of SBP <140