Remote cerebellar hemorrhage as complication of spinal surgery

Abstract

Introduction: The occurrence of remote cerebellar hemorrhage (RCH) during spinal surgery is a rare event and can go undetected in the majority of cases. A mortality rate of almost 15% has been reported. Case report: We present two cases of patients presenting with cerebellar hemorrhage after lumbar spine surgery complicated with dural rupture. A review of its physiopathological mechanisms is made. In both cases the diagnosis was made during the investigation of neurological deficits in early postoperative period. In the first case, there was dural rupture due to disruption of the pre-existing vertebral osteosynthesis material. In the second case, the existence of a dural fistula was noticed after the procedure, responsible for the cerebrospinal fluid (CSF) leakage. Neuroimaging studies of two patients showed the classic “zebra-sign”. Expectant treatment was applied in both cases, with complete recovery of symptoms. Discussion: The pathophysiological mechanism of RCH is still unknown, but it’s supposed that it is due to intracranial hypotension caused by CSF leakage, which causes a caudal displacement of the cerebellum, that might lead to stretching and disruption of the vermian veins. Expectanttreatment can be applied in cases of minor bleeding, with surgical evacuation in cases of major bleeds. Prognosis is usually favorable, with minor transient neurological deficits.