Amin et al. Journal of Medical Case Reports 2011, 5:360 http://www.jmedicalcasereports.com/content/5/1/360 Page 2 of 4 Figure 1 Non-contrast brain CT scan of the patient, which was done approximately four hours after developing her symptoms. Note that the hematoma lies at the deep right cerebellar hemisphere and is surrounded by mild cytotoxic edema. The fourth ventricle was not compressed and brainstem signs were absent. Figure 2 Non-contrast brain CT scan of the same patient, which was done about 2 hours after the re-bleed. The second hemorrhage lies at the left deep dentate nuclei and is not surrounded by edema, implying a very recent development. The first hematoma at the right cerebellar hemisphere had resolved, leaving a small slit. week period. On discharge, her speech was scanning and her gait was wide-based and ataxic. She could stand and walk alone with minor assistance. Because of the lack of expertise in our radiology department, conventional cer- ebral angiography was not ordered; however, a brain magnetic resonance angiogram (MRA) was done two weeks later and the result was unremarkable. We assume that our patient’s hemorrhages were hyperten- sive in etiology. Discussion Mohr et al. [1] analyzed 694 hospitalized stroke patients and found that intra-cerebral hemorrhage (ICH) is the third most common cause of stroke; embolic ischemic stroke and atherothrombotic infarction ranked second and first on that list of frequency, respectively. ICH con- stitutes 10% to 15% of all stroke subtypes [2]. Long-standing arterial hypertension is responsible for about 50% of all cases of primary ICH [3], and accord- ing to Thrift and colleagues [4] this hypertension dou- bles the risk of developing ICH. The necrotizing effect of long-standing hypertension on the wall of small pene- trating blood vessels (<300 μm in diameter) leads to the formation of Charcot-Bouchard micro-aneurysms; rup- ture of the latter leads to intra-parenchymal hemorrhage [5]. Approximately 20% of hypertensive hemorrhages develop in the posterior fossa; the rest are supratento- rially located. In the cerebellum, the small penetrating branches of superior cerebellar arteries (and posterior inferior cerebellar arteries to a lesser extent) on either side are the usual target for micro-aneurysmal formation [6-8]. Therefore, most hemorrhages appear in the region of the dentate nuclei. These cerebellar hemorrhages account for approximately 5% to 15% of all primary ICHs [9-12]; the cerebellum is the fourth most common site for spontaneous ICHs, trailing thalamic, lobar, and putamenal hemorrhages [13]. In 1984, Kunitz and coworkers [14] respectively ana- lyzed the NINCDS Stroke Data Bank. Only one out of 101 patients with hemorrhagic strokes had a history of intra-cerebral hemorrhage. Therefore, primary sponta- neous ICH can be considered a one-time event. Douglas and Haerer [15] found that hypertensive intra-cerebral hemorrhages, unlike Berry’s aneurysms, rarely, if ever, re-bleed at the same site. On the other hand, patients are not likely to have a second bleed in another location. According to Gonzalez-Duarte and colleagues [16], recurrent hypertensive intra-cerebral hemorrhages do occur, but at a very low rate, and the main topographic pattern of re-bleeding is basal ganglionic-ganglionic. Non-hypertensive recurrent hemorrhages tend to be lobar in location, in contrast to the hypertensive ones. Bae and associates [17] concluded that the recurrence rate is 5.4% and that most recurrences develop within