Accidente cerebrovascular isquémico de fosa posterior: manejo quirúrgico - cirugía en infarto de cerebelo, ¿Cuándo?

Abstract

Cerebellum infarction can be difficult to diagnose especially when symptoms are nonspecific such as nausea, vomiting, and dizziness. Special attention should be paid to eye movements, speech, coordination, and ataxia. Cerebellum infarction with pseudotumor evolution is characterized by edema that produces compression of the brain stem and acute hydrocephalus secondary to the compression of the 4^th ventricle, and often both. The main symptom is the decreased level of consciousness, ophthalmosparesis and cardiovascular alterations may appear. Brain CT and MRI are still the most useful techniques for diagnosis, although initial CT can be normal in up to 25% of patients. The peak of edema and clinical deterioration occurs between 72-120 h. Decompressive craniectomy in cerebellar infarction with pseudotumor evolution is much less frequent than in malignant infarctions of the anterior circulation. The evolution of each individual is idiosyncratic. We reported two cases in our center during the last three years.