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Traumatic damage in the posterior fossa is a relatively rare event. A case of a 52-year-old alcoholic is reported who had two severe head traumas during a fight. The subsequent complaints consisted in vertigo and ataxia and were related to a post-commotional syndrome or damage due to chronic alcoholism. The neurological work-up, which was performed a few months later showed typical signs of traumatic damage of the cerebellum. This was confirmed by axial CT-scan.

Clinical examination of severe brain injuries often suggests involvement of the brain stem and pontine structures not only via functional but also via structural lesions. Computer tomographic evidence of infratentorial trauma, however appears comparably rarely. 32 of 436 brain injured patients examined by CT showed traumatic infratentorial lesions. We examined these patients with regard to the distribution of structural damage, place of primary impact of force, incidence of skull fractures and accompanying supratentorial injuries, initial clinical status and clinical outcome. All but 2 patients were primarily unconscious. The lethal outcome in 7 patients was presumably due to the traumatic involvement of supratentorial structures. Patients with mainly infratentorial lesions--even with large epidural haematoma--showed a good recovery and fair rehabilitative outcome if the operation was performed immediately.