Bilateral Cerebellar Haemorrhage after Lumbar Drain Placement in a Case of Primary Intraventricular Bleed- Complication Revisited

Abstract

Background and Importance: Lumbar drain placement and diversion of cerebrospinal fluid is a therapeutic procedure, often done bedside to accentuate wound healing in case of dural transgression following cranial or spinal procedures. Indications include cases of open head injuries with Cerebrospinal fluid (CSF) leak and for re-establishment of CSF flow in primary intraventricular bleed with prolonged periods of External ventricular drain (EVD) placement. Complications include central herniation as a result of over drainage of spinal fluid, low-pressure headache and, in some cases profound dyselectrolytemia and nausea and vomiting. Clinical Presentation: We illustrate a complication, which presented to us, in a 42-year old gentleman with primary intraventricular bleed with EVD in situ. Lumbar drain placement was planned to re-establish CSF flow and for EVD removal, however, once spinal fluid was drained patient deteriorated neurologically. He developed a tight posterior fossa secondary to tonsillar herniation with vermian foliar haemorrhage and had to undergo emergency surgical decompression as a salvage procedure. Conclusions: Herniation following CSF diversion is a known complication, however, they are less often seen after a lumbar drain placement. Early clinical suspicion and posterior fossa decompression can prevent, the otherwise, lethal outcome in such patients. Here we discuss the complications that ensued and the management thereafter in this clinical vignette.