Patient handout

Intracerebral Hemorrhage — Cerebellar (emergent decompression)

PRODUCTION

1. Your condition

This handout is for intracerebral hemorrhage — cerebellar (emergent decompression). Your care team identified this based on: non-contrast ct head showing cerebellar intraparenchymal blood (aha/asa 2022 pmid 35579034).

Other reasons your team may use this plan: sudden ataxia + vertigo + vomiting + occipital headache (often mistaken for benign vertigo — hints pivot; newman-toker stroke 2009 pmid 19762709); altered consciousness from brainstem compression / hydrocephalus (aha/asa 2022); on vka / doac / heparin at presentation (annexa-i pmid 38749032).

3. When to call your provider

Contact your care team if any of the following happen:

Any new neurologic event → ED
Worsening ataxia → MRI for recurrent bleed / progressive lesion
BP persistently >140/90 → resistant HTN workup
PHQ-9 ≥15 or SI → urgent psych referral
AVM-related recurrence → re-image, escalate to vascular neurosurgery

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Cerebellar ICH ≥3 cm OR brainstem compression OR obstructive hydrocephalus from cerebellar mass effect (AHA/ASA 2022 Class I)(life-threatening)
Cerebellar ICH with 4th-ventricle compression → obstructive hydrocephalus → STAT EVD (AHA/ASA 2022)(life-threatening)
Cerebellar ICH (any volume) with GCS decline post-admission → STAT decompressive craniectomy even if initial volume <3 cm (AHA/ASA 2022)(life-threatening)
Cerebellar ICH presenting with predominant ataxia / vertigo / vomiting / headache — often mistaken for benign vestibular disorder (HINTS pivot; Newman-Toker Stroke 2009 PMID 19762709)
Cerebellar ICH from underlying AVM rupture — MRI / DSA for vascular lesion workup (AHA/ASA 2022)
Cerebellar ICH on VKA / DOAC at presentation — STAT reversal regardless of dose timing (AHA/ASA 2022; ANNEXA-I PMID 38749032; INCH PMID 27302126)
Pediatric cerebellar ICH — AVM rupture is the leading cause; MRI + DSA mandatory; STAT pediatric neurosurgery (AHA/ASA 2022)

5. Follow-up

Long-term BP <130/80 (SPRINT-MIND); MRI for underlying vascular cause in young / atypical; phenotype-specific secondary prevention; cerebellar rehab; PHQ-9 + MoCA; driving evaluation (cerebellar ataxia affects driving) (AHA/ASA 2022)

6. Sources

Guideline: 2022 AHA/ASA Guideline for Spontaneous ICH (Greenberg Stroke 2022) — Class I cerebellar ≥3 cm decompression + INTERACT3 + HINTS pivot + ANNEXA-I reversal