Neurological outcome of patients with a non-traumatic infratentorial cerebellar haematoma admitted to the intensive care unit.

Non-traumatic infratentorial cerebellar haematomas can occur spontaneously or secondarily to a vascular malformation, leading to life-threatening conditions that can necessitate surgical or radiological interventions and admission to the Neurological Intensive Care Unit (NICU). We conducted a retrospective, single-centre observational study over a 17-year period (2005-2022) involving all adult patients admitted to the NICU of a French tertiary centre with a diagnosis of non-traumatic infratentorial cerebellar brain haematoma. Among the 88 patients (median age 58 (interquartile range (IQR) 48-67) years) included in the study, a vascular malformation was found in 36 patients (41%). Surgical evacuation of the haematoma or a radio-embolisation procedure was performed in 53 patients (60%) and 18 patients (20%) respectively. Median length of NICU stay was 26 (IQR 12-45) days, and prolonged ventilatory support (>21 days) was necessary in 35 patients (40%). In NICU survivors, awareness recovery occurred at a median of 3 (IQR 1-6) days after discontinuation of sedation. NICU mortality was 19% (n = 17), and 97% (n = 62) of the NICU survivors who were included in the three-month follow-up were alive, while 56% (n = 36) had a favourable neurological outcome (modified Rankin Scale (mRS) ⩽ 3). We found a significant association between an unfavourable neurological outcome (three-month mRS score > 3) and advanced age (P = 0.004), pre-existing antithrombotic therapy (P = 0.04), low Glasgow Coma Scale score on admission (P < 0.001), presence of a ventricular haemorrhage (P = 0.04), presence of brainstem compression (P < 0.001) and delay in awareness recovery (P = 0.005). Among patients with a cerebellar haematoma and impaired alertness, half will have a favourable outcome at three months. Further studies are needed to explore these results over time and at other centres.