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 so Emergency providers should be prepared to intubate if necessary.

•Patients with cerebellar hemorrhages that are >3cm in diameter, have 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 actually 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