Treatment of Hypertensive Cerebellar Hemorrhage–Surgical or Conservative Management?

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Abstract
To the Editor: Kobayashi and colleagues (1) recently reported their management criteria for spontaneous cerebellar hematomas. They proposed that patients with Glasgow Coma Scale (GCS) scores of 14 or 15 with a hematoma measuring less than 40 mm in maximum diameter should be treated conservatively, whereas for patients with GCS scores of 13 or less at the time of admission or with a hematoma measuring 40 mm or more, hematoma evacuation with decompressive suboccipital craniectomy should be the treatment of choice; for the patient whose brain stem reflexes are entirely lost with flaccid tetraplegia or whose general condition is poor, intensive therapy is not indicated. Unfortunately, their criteria are lacking in several respects: abnormalities in brain stem reflexes may not reflect an irreversible surgical problem; in addition, those authors did not factor in the presence of hydrocephalus (HY). Most importantly, their criteria did not have prognostic value in...

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