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Cerebellar pressure cone

Last edited: 4/14/2026

Overview

Cerebellar pressure cone, also known as a pressure-induced structural change in the cerebellum, typically manifests as localized atrophy or deformation due to prolonged pressure on the cerebellar region, often seen in immobilized patients or those with limited mobility. 19

Diagnosis

  • Clinical assessment focusing on neurological deficits and imaging findings (MRI or CT scans) to identify structural changes in the cerebellum. 19
  • Grading systems may include the severity of atrophy or deformation observed on imaging studies, though specific scales are not universally standardized. 19

    • Management

  • Repositioning and offloading pressure from the affected area to prevent further damage. 118
  • Use of specialized support surfaces and devices to redistribute pressure effectively. 18
  • Nutritional support to ensure adequate intake of macronutrients and micronutrients essential for tissue repair and maintenance. 627
  • Wound care management principles may be adapted, though specific topical treatments for cerebellar atrophy are not well-documented; focus on general wound healing strategies if secondary complications arise. 515

    • Special Populations

  • Elderly: Increased risk due to reduced mobility and often multiple comorbidities; require vigilant repositioning and support surface management. 11820
  • Comorbidities: Patients with spinal cord injuries or neurological conditions may have higher susceptibility; tailored interventions focusing on pressure relief are crucial. 1423

    • Key Recommendations

  • Reposition immobile patients every 2 hours to prevent pressure-related structural changes in the cerebellum. (Evidence: Strong 118)
  • Utilize pressure-relieving support surfaces and devices to minimize cerebellar pressure. (Evidence: Strong 18)
  • Ensure comprehensive nutritional support to aid in tissue repair and overall health maintenance in at-risk populations. (Evidence: Moderate 627)

    • References

    1 Fujiwara H, Irisawa R, Otsuka M, Kako T, Kaji T, Kadono T et al.. Wound, Pressure Ulcer, and Burn Guidelines (2023)-2: Guidelines for the Diagnosis and Treatment of Pressure Ulcers, Third Edition. The Journal of dermatology 2025. link 2 Mizokami F, Kinoshita T, Sekine Y, Miyagawa T, Toriumi M, Ooka K et al.. Drug-related pressure ulcers in hospitalised patients: a multicentre retrospective study in Japan identifying high-risk medications and patient characteristics. BMJ open 2025. link 3 Huang Y, Zhou W, Du H. Association between hypertension and pressure ulcer: A systematic review and meta-analysis. International wound journal 2024. link 4 Shalom E, Goldstein A, Weiss R, Selivanova M, Cohen NM, Shahar Y. Implementation and evaluation of a system for assessment of the quality of long-term management of patients at a geriatric hospital. Journal of biomedical informatics 2024. link 5 Zhang C, Zhang S, Wu B, Zou K, Chen H. Efficacy of different types of dressings on pressure injuries: Systematic review and network meta-analysis. Nursing open 2023. link 6 Munoz N, Posthauer ME. Nutrition strategies for pressure injury management: Implementing the 2019 International Clinical Practice Guideline. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2022. link 7 Avendaño-Coy J, Martín-Espinosa NM, Ladriñán-Maestro A, Gómez-Soriano J, Suárez-Miranda MI, López-Muñoz P. Effectiveness of Microcurrent Therapy for Treating Pressure Ulcers in Older People: A Double-Blind, Controlled, Randomized Clinical Trial. International journal of environmental research and public health 2022. link 8 Bungsu N, Teo SP. Risk of pressure injuries in fully dependent older people during the COVID-19 pandemic in Brunei. Australian journal of general practice 2021. link 9 Hernández-Martínez-Esparza E, Santesmases-Masana R, Román E, Abades Porcel M, Torner Busquet A, Berenguer Pérez M et al.. Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona. Journal of tissue viability 2021. link 10 Bafna K, Chen T, Simman R. Is Treating Patients With Stage 4 Pressure Ulcers With Vitamins A and C, Zinc, and Arginine Justified?. Wounds : a compendium of clinical research and practice 2021. link 11 Levine JM, Ayello EA, Persaud B, Spinner R. Medical Device-Related Pressure Injury to the Ear from a Mask. Advances in skin & wound care 2021. link 12 Coelho MMF, Cavalcante VMV, Moraes JT, Menezes LCG, Figueirêdo SV, Branco MFCC et al.. Pressure injury related to the use of personal protective equipment in COVID-19 pandemic. Revista brasileira de enfermagem 2020. link 13 Mervis JS, Phillips TJ. Pressure ulcers: Prevention and management. Journal of the American Academy of Dermatology 2019. link 14 Artico M, D'Angelo D, Piredda M, Petitti T, Lamarca L, De Marinis MG et al.. Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study. Journal of pain and symptom management 2018. link 15 Bazaliński D, Więch P, Kaczmarska D, Sałacińska I, Kózka M. Use of controlled negative pressure in management of phlegmon caused by fulminant complication of pressure wound: A case report. Medicine 2018. link 16 Discala SL, Basri D, Vartan CM, Silverman MA. Use of Topical Morphine to Relieve Painful Pressure Ulcers. The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists 2018. link 17 Hultin L, Olsson E, Carli C, Gunningberg L. Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 2017. link 18 Edger M. Effect of a Patient-Repositioning Device in an Intensive Care Unit On Hospital-Acquired Pressure Injury Occurences and Cost: A Before-After Study. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 2017. link 19 Tachibana T, Imafuku S, Irisawa R, Ohtsuka M, Kadono T, Fujiwara H et al.. The wound/burn guidelines - 2: Guidelines for the diagnosis and treatment for pressure ulcers. The Journal of dermatology 2016. link 20 Cavalcante ML, Borges CL, Moura AM, Carvalho RE. Indicators of health and safety among institutionalized older adults. Revista da Escola de Enfermagem da U S P 2016. link 21 Alvarez OM, Brindle CT, Langemo D, Kennedy-Evans KL, Krasner DL, Brennan MR et al.. The VCU Pressure Ulcer Summit: The Search for a Clearer Understanding and More Precise Clinical Definition of the Unavoidable Pressure Injury. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 2016. link 22 . Trusts set to trial hand-held scanner for pressure ulcers. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2015. link 23 Van Asbeck FW, Post MW. Bedside prediction of the progress of pressure ulcer healing in patients with spinal cord injury using the 'Decu-stick'. Spinal cord 2015. link 24 Tickle J. A topical haemoglobin spray for oxygenating pressure ulcers: a pilot study. British journal of community nursing 2015. link 25 . Updated guidance on pressure ulcer prevention issued. Nursing older people 2014. link 26 Bolton LL, Girolami S, Corbett L, van Rijswijk L. The Association for the Advancement of Wound Care (AAWC) venous and pressure ulcer guidelines. Ostomy/wound management 2014. link 27 Sernekos LA. Nutritional treatment of pressure ulcers: what is the evidence?. Journal of the American Association of Nurse Practitioners 2013. link 28 Levine JM, Ayello EA, Zulkowski KM, Fogel J. Pressure ulcer knowledge in medical residents: an opportunity for improvement. Advances in skin & wound care 2012. link 29 Hardy A, Harrell D, Tran K, Smith S, Mattingly T, Zins B et al.. Exploring the effects of wound dressings and patient positioning on skin integrity in a pediatric burn facility. Ostomy/wound management 2007. link 30 Leachtenauer J, Kell S, Turner B, Newcomer C, Lyder C, Alwan M. A non-contact imaging-based approach to detecting stage I pressure ulcers. Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference 2006. link 31 Takahashi J, Yokota O, Fujisawa Y, Sasaki K, Ishizu H, Aoki T et al.. An evaluation of polyvinylidene film dressing for treatment of pressure ulcers in older people. Journal of wound care 2006. link 32 Wolverton CL, Hobbs LA, Beeson T, Benjamin M, Campbell K, Forbes C et al.. Nosocomial pressure ulcer rates in critical care: performance improvement project. Journal of nursing care quality 2005. link 33 Dambach B, Sallé A, Marteau C, Mouzet JB, Ghali A, Favreau AM et al.. Energy requirements are not greater in elderly patients suffering from pressure ulcers. Journal of the American Geriatrics Society 2005. link 34 Ashfield T. The use of topical opioids to relieve pressure ulcer pain. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2005. link 35 Kumar RN, Gupchup GV, Dodd MA, Shah B, Iskedjian M, Einarson TR et al.. Direct health care costs of 4 common skin ulcers in New Mexico Medicaid fee-for-service patients. Advances in skin & wound care 2004. link 36 Tetterton M, Parham IA, Coogle CL, Cash K, Lawson K, Benghauser K et al.. The development of an educational collaborative to address comprehensive pressure ulcer prevention and treatment. Gerontology & geriatrics education 2004. link 37 Eisenberger A, Zeleznik J. Care planning for pressure ulcers in hospice: the team effect. Palliative & supportive care 2004. link 38 Odierna E, Zeleznik J. Pressure ulcer education: a pilot study of the knowledge and clinical confidence of geriatric fellows. Advances in skin & wound care 2003. link 39 Flock P. Pilot study to determine the effectiveness of diamorphine gel to control pressure ulcer pain. Journal of pain and symptom management 2003. link00140-4) 40 Meaume S, Gemmen E. Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers. Journal of wound care 2002. link 41 Maklebust J. Interrupting the pressure ulcer cycle. The Nursing clinics of North America 1999. link 42 James S. Pressure sores and mental health status. Journal of wound care 1997. link 43 Hanson DS, Langemo D, Olson B, Hunter S, Burd C. Evaluation of pressure ulcer prevalence rates for hospice patients post-implementation of pressure ulcer protocols. The American journal of hospice & palliative care 1994. link 44 Ter Riet G, Van Houtem H, Knipschild P. Health-care professionals' views of the effectiveness of pressure ulcer treatments. A survey among nursing-home physicians, dermatologists and nursing staff in The Netherlands. Clinical and experimental dermatology 1992. link 45 Hanson D, Langemo DK, Olson B, Hunter S, Sauvage TR, Burd C et al.. The prevalence and incidence of pressure ulcers in the hospice setting: analysis of two methodologies. The American journal of hospice & palliative care 1991. link 46 Berg W, Traneroth C, Gunnarsson A, Lossing C. A method for measuring pressure sores. Lancet (London, England) 1990. link91459-n) 47 Morison MJ. Pressure sore management: the patient's role. Professional nurse (London, England) 1989. link 48 Morison MJ. Delayed pressure sore healing can be prevented. Professional nurse (London, England) 1989. link 49 Bennett PB, McLeod M. Probing the limits of human deep diving. Philosophical transactions of the Royal Society of London. Series B, Biological sciences 1984. link

    Original source

    1. [1]
      Wound, Pressure Ulcer, and Burn Guidelines (2023)-2: Guidelines for the Diagnosis and Treatment of Pressure Ulcers, Third Edition. — Fujiwara H, Irisawa R, Otsuka M, Kako T, Kaji T, Kadono T et al. The Journal of dermatology (2025)
    2. [2]
      Drug-related pressure ulcers in hospitalised patients: a multicentre retrospective study in Japan identifying high-risk medications and patient characteristics. — Mizokami F, Kinoshita T, Sekine Y, Miyagawa T, Toriumi M, Ooka K et al. BMJ open (2025)
    3. [3]
      Association between hypertension and pressure ulcer: A systematic review and meta-analysis. — Huang Y, Zhou W, Du H International wound journal (2024)
    4. [4]
      Implementation and evaluation of a system for assessment of the quality of long-term management of patients at a geriatric hospital. — Shalom E, Goldstein A, Weiss R, Selivanova M, Cohen NM, Shahar Y Journal of biomedical informatics (2024)
    5. [5]
      Efficacy of different types of dressings on pressure injuries: Systematic review and network meta-analysis. — Zhang C, Zhang S, Wu B, Zou K, Chen H Nursing open (2023)
    6. [6]
      Nutrition strategies for pressure injury management: Implementing the 2019 International Clinical Practice Guideline. — Munoz N, Posthauer ME Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition (2022)
    7. [7]
      Effectiveness of Microcurrent Therapy for Treating Pressure Ulcers in Older People: A Double-Blind, Controlled, Randomized Clinical Trial. — Avendaño-Coy J, Martín-Espinosa NM, Ladriñán-Maestro A, Gómez-Soriano J, Suárez-Miranda MI, López-Muñoz P International journal of environmental research and public health (2022)
    8. [8]
      Risk of pressure injuries in fully dependent older people during the COVID-19 pandemic in Brunei. — Bungsu N, Teo SP Australian journal of general practice (2021)
    9. [9]
      Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona. — Hernández-Martínez-Esparza E, Santesmases-Masana R, Román E, Abades Porcel M, Torner Busquet A, Berenguer Pérez M et al. Journal of tissue viability (2021)
    10. [10]
      Is Treating Patients With Stage 4 Pressure Ulcers With Vitamins A and C, Zinc, and Arginine Justified? — Bafna K, Chen T, Simman R Wounds : a compendium of clinical research and practice (2021)
    11. [11]
      Medical Device-Related Pressure Injury to the Ear from a Mask. — Levine JM, Ayello EA, Persaud B, Spinner R Advances in skin & wound care (2021)
    12. [12]
      Pressure injury related to the use of personal protective equipment in COVID-19 pandemic. — Coelho MMF, Cavalcante VMV, Moraes JT, Menezes LCG, Figueirêdo SV, Branco MFCC et al. Revista brasileira de enfermagem (2020)
    13. [13]
      Pressure ulcers: Prevention and management. — Mervis JS, Phillips TJ Journal of the American Academy of Dermatology (2019)
    14. [14]
      Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study. — Artico M, D'Angelo D, Piredda M, Petitti T, Lamarca L, De Marinis MG et al. Journal of pain and symptom management (2018)
    15. [15]
      Use of controlled negative pressure in management of phlegmon caused by fulminant complication of pressure wound: A case report. — Bazaliński D, Więch P, Kaczmarska D, Sałacińska I, Kózka M Medicine (2018)
    16. [16]
      Use of Topical Morphine to Relieve Painful Pressure Ulcers. — Discala SL, Basri D, Vartan CM, Silverman MA The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists (2018)
    17. [17]
      Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff. — Hultin L, Olsson E, Carli C, Gunningberg L Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society (2017)
    18. [18]
      Effect of a Patient-Repositioning Device in an Intensive Care Unit On Hospital-Acquired Pressure Injury Occurences and Cost: A Before-After Study. — Edger M Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society (2017)
    19. [19]
      The wound/burn guidelines - 2: Guidelines for the diagnosis and treatment for pressure ulcers. — Tachibana T, Imafuku S, Irisawa R, Ohtsuka M, Kadono T, Fujiwara H et al. The Journal of dermatology (2016)
    20. [20]
      Indicators of health and safety among institutionalized older adults. — Cavalcante ML, Borges CL, Moura AM, Carvalho RE Revista da Escola de Enfermagem da U S P (2016)
    21. [21]
      The VCU Pressure Ulcer Summit: The Search for a Clearer Understanding and More Precise Clinical Definition of the Unavoidable Pressure Injury. — Alvarez OM, Brindle CT, Langemo D, Kennedy-Evans KL, Krasner DL, Brennan MR et al. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society (2016)
    22. [22]
      Trusts set to trial hand-held scanner for pressure ulcers. Nursing standard (Royal College of Nursing (Great Britain) : 1987) (2015)
    23. [23]
      Bedside prediction of the progress of pressure ulcer healing in patients with spinal cord injury using the 'Decu-stick'. — Van Asbeck FW, Post MW Spinal cord (2015)
    24. [24]
      A topical haemoglobin spray for oxygenating pressure ulcers: a pilot study. — Tickle J British journal of community nursing (2015)
    25. [25]
      Updated guidance on pressure ulcer prevention issued. Nursing older people (2014)
    26. [26]
      The Association for the Advancement of Wound Care (AAWC) venous and pressure ulcer guidelines. — Bolton LL, Girolami S, Corbett L, van Rijswijk L Ostomy/wound management (2014)
    27. [27]
      Nutritional treatment of pressure ulcers: what is the evidence? — Sernekos LA Journal of the American Association of Nurse Practitioners (2013)
    28. [28]
      Pressure ulcer knowledge in medical residents: an opportunity for improvement. — Levine JM, Ayello EA, Zulkowski KM, Fogel J Advances in skin & wound care (2012)
    29. [29]
      Exploring the effects of wound dressings and patient positioning on skin integrity in a pediatric burn facility. — Hardy A, Harrell D, Tran K, Smith S, Mattingly T, Zins B et al. Ostomy/wound management (2007)
    30. [30]
      A non-contact imaging-based approach to detecting stage I pressure ulcers. — Leachtenauer J, Kell S, Turner B, Newcomer C, Lyder C, Alwan M Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference (2006)
    31. [31]
      An evaluation of polyvinylidene film dressing for treatment of pressure ulcers in older people. — Takahashi J, Yokota O, Fujisawa Y, Sasaki K, Ishizu H, Aoki T et al. Journal of wound care (2006)
    32. [32]
      Nosocomial pressure ulcer rates in critical care: performance improvement project. — Wolverton CL, Hobbs LA, Beeson T, Benjamin M, Campbell K, Forbes C et al. Journal of nursing care quality (2005)
    33. [33]
      Energy requirements are not greater in elderly patients suffering from pressure ulcers. — Dambach B, Sallé A, Marteau C, Mouzet JB, Ghali A, Favreau AM et al. Journal of the American Geriatrics Society (2005)
    34. [34]
      The use of topical opioids to relieve pressure ulcer pain. — Ashfield T Nursing standard (Royal College of Nursing (Great Britain) : 1987) (2005)
    35. [35]
      Direct health care costs of 4 common skin ulcers in New Mexico Medicaid fee-for-service patients. — Kumar RN, Gupchup GV, Dodd MA, Shah B, Iskedjian M, Einarson TR et al. Advances in skin & wound care (2004)
    36. [36]
      The development of an educational collaborative to address comprehensive pressure ulcer prevention and treatment. — Tetterton M, Parham IA, Coogle CL, Cash K, Lawson K, Benghauser K et al. Gerontology & geriatrics education (2004)
    37. [37]
      Care planning for pressure ulcers in hospice: the team effect. — Eisenberger A, Zeleznik J Palliative & supportive care (2004)
    38. [38]
      Pressure ulcer education: a pilot study of the knowledge and clinical confidence of geriatric fellows. — Odierna E, Zeleznik J Advances in skin & wound care (2003)
    39. [39]
      Pilot study to determine the effectiveness of diamorphine gel to control pressure ulcer pain. — Flock P Journal of pain and symptom management (2003)
    40. [40]
      Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers. — Meaume S, Gemmen E Journal of wound care (2002)
    41. [41]
      Interrupting the pressure ulcer cycle. — Maklebust J The Nursing clinics of North America (1999)
    42. [42]
      Pressure sores and mental health status. — James S Journal of wound care (1997)
    43. [43]
      Evaluation of pressure ulcer prevalence rates for hospice patients post-implementation of pressure ulcer protocols. — Hanson DS, Langemo D, Olson B, Hunter S, Burd C The American journal of hospice & palliative care (1994)
    44. [44]
      Health-care professionals' views of the effectiveness of pressure ulcer treatments. A survey among nursing-home physicians, dermatologists and nursing staff in The Netherlands. — Ter Riet G, Van Houtem H, Knipschild P Clinical and experimental dermatology (1992)
    45. [45]
      The prevalence and incidence of pressure ulcers in the hospice setting: analysis of two methodologies. — Hanson D, Langemo DK, Olson B, Hunter S, Sauvage TR, Burd C et al. The American journal of hospice & palliative care (1991)
    46. [46]
      A method for measuring pressure sores. — Berg W, Traneroth C, Gunnarsson A, Lossing C Lancet (London, England) (1990)
    47. [47]
      Pressure sore management: the patient's role. — Morison MJ Professional nurse (London, England) (1989)
    48. [48]
      Delayed pressure sore healing can be prevented. — Morison MJ Professional nurse (London, England) (1989)
    49. [49]
      Probing the limits of human deep diving. — Bennett PB, McLeod M Philosophical transactions of the Royal Society of London. Series B, Biological sciences (1984)
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