SPACE-OCCUPYING CEREBELLAR INFARCTION

About 20% of cerebellar infarcts are space occupying. The expanding posterior fossa mass causes direct brain stem compression, hydrocephalus by occlusion of the fourth ventricle, and sometimes upward transtentorial herniation. This results in secondary brain stem symptoms and an increasing disturbance of consciousness two to four days after the stroke. Coma, posturing, ataxic respiration may develop within 24 hours. So patients must be monitored in an intensive care unit. It seems evident now, that many patients with massive cerebellar infarction only survive by neurosurgical intervention. Decompressive suboccipital craniectomy with removal of infarcted tissue is the most propagated surgical procedure. Nevertheless, there is no general agreement about the optimal timing and type of surgical intervention at present.