Symptom improvement following ICH?

Suffered a left-sided intracerebellar hemorrhage over four years ago with symptoms of double vision and very slight problem with balance which resolved completely within about five months.  Second hemorrhage (also left-sided) not quite four months ago with more significant bleeding.  Impairment more pronounced with continued double vision and left-sided ataxia, difficulty with balance and use of left arm and hand.  MRI,cerebral angiogram and CT scans reveal a capillary hemangioma and a venous angioma in close proximity to each other in the cerebellum.  Neurosurgeons have reviewed and cannot determine for sure which lesion has bled.  In such cases, what percentage of resolution of symptoms is expected?  That is, can I expect full resolution as with the first episode or will there necessarily be some residual impairment since bleeding has occurred on two occasions? Double vision has improved; moved from inability to walk without assistance to using a cane; some ataxia persists on the left side.

[CCF Neuro[P] MD, RPS]

Dear John:

Sorry to hear about your intracerebellar bleeds.  Since I cannot see your MRI or note your neurological exam personally it is difficult for me to tell you information specifically pertaining to your residual impairment.  Most of the time, there is some improvement but the extent of improvement depends on the type of lesion etiology, the extent of the lesion, where the lesion occurred, rehab, patient individual characteristics, and what the patient expects.  Not knowing which of your abnormalities caused the bleeding makes it difficult to give a prognosis, as cavernous angiomas can rebleed (although the incidence of new rebleeding is not high) as can capillary hemangioma.  Given these things, most improvement occurs over the first 6-12 months at which point there is a plateau of major improvements.  Obviously, the more trauma to a particular area puts that area at greater risk for not recovering and this is especially true as the area becomes more eloquent (controlling finer movements or cognition such as language).  The cerebellum is necessary for co-ordination of movement (thus your ataxia) and depending on where the lesion might be speech articulation, muscle tone, etc.  

So, the recovery from the second bleed is still most likely occuring while the initial bleed was likely as recovered as it could be.  Whether there was an additive effect of the second bleed depends on it the initial etiology reoccurred or it was a new area in the cerebellum.  Sorry, I can't help much more.

Sincerely,

CCF Neuro MD