Remote Cerebellar Hemorrhage Research Articles

Remote cerebellar hemorrhage after lumbar spinal surgery

Remote cerebellar hemorrhage (RCH) is a rare complication after supratentorial or spinal surgery. RCH is poorly known and hence probably underdiagnosed. Diminished consciousness and headache are the most common clinical features. Computed tomography and magnetic resonance reveal a characteristic pattern of linear bleeding between the cerebellar folia. The pathophysiological mechanism is disputed but is probably venous bleeding secondary to significant intraoperative or postoperative loss of cerebrospinal fluid. Multiple risk factors have been described, but postsurgical negative pressure drainage of cerebrospinal fluid is the only clearly predisposing factor. We present a case of RCH after spinal surgery with a literature review.

Does ventricular opening promote remote cerebellar haemorrhage ?

Cerebellar haemorrhage after supratentorial craniotomy is a rare complication Because of its significant morbidity and mortality rates, being aware of this complication is important for early diagnosis. In a 30-year-old male with multiple intracranial cavernomas, remote cerebellar haemorrhage (RCH) was observed after removal of symptomatic left temporal lesion. The lateral wall of the temporal horn that was tightly attached to the cavernoma was also opened and excessive drainage of the CSF occurred. The haemorrhage is attributed to opening of the ventricle wall and excessive drainage of cerebrospinal fluid (CSF) during the procedure.

Remote Cerebellar Hemorrhage after Spinal Surgery

This report details a case of a 56-year-old woman who presented with a herniated lumbar disc at L4-5 with congenital spondylolisthesis (grade II) and developed remote cerebellar hemorrhage following an iatrogenic acute reduction in cerebrospinal fluid (CSF) pressure during spinal interbody fusion. Possible mechanisms are discussed: however, pathological events leading to this complication are unclear. Intracranial hemorrhage (ICH) must be considered in patient presenting with unexplained neurological deterioration not attributable to the spinal surgery, especially when the dura has been opened followed by significant CSF loss. (J Kor Neurotraumatol Soc 2010;6:162-164)

Supratentorial craniotomy complicated by an homolateral remote cerebellar hemorrhage and a controlateral perisylvian infarction: case report

The authors present the case of a 49-year-old male patient with a right remote cerebellar hemorrhage and left perisylvian venous infarction complicating a right supratentorial craniotomy for temporal meningomia resection. These two events may result from a functional stenosis (due to perioperative brainstem sag) of the junction between the vein of Galen and the straight sinus. Remote cerebellar hemorrhage could then be explained by infarction in the territory of cerebellar veins emptying in the vein of Galen, and the left perisylvian infarction could be caused by venous infarction in the territory of a dominant superficial sylvian vein emptying in the basal vein. This hypothesis could shed light on the pathophysiology of remote cerebellar hemorrhage.

未破裂脳動脈瘤の外科手術の合併症とその対策―慢性硬膜下血腫および後頭蓋窩出血の発生予防―

Postoperative chronic subdural hematoma (CSH) and remote cerebellar hemorrhage (RCH) is one of the important complications for treatment of unruptured intracranial aneurysm. The purpose of this study was to determine how to prevent CSH and RCH following the treatment of unruptured intracranial aneurysms. Between January 2000 and December 2007, 290 patients underwent clipping for unruptured intracranial aneurysms at our institution. We studied the patient's age and sex, location, size and multiplicity of aneurysm, the craniotomy site, the operative time required, operator and the procedure and the methods of anesthesia. We also reviewed the findings and outcomes of CSH and RCH. The incidence was 4.4% (males, 9.5%; females, 2.9%) and the mean age was 65 years with CSH. The incidence of RCH was 6.0% (males, 6.8%; females, 5.8%) and the mean age was 59.5 years. There was no statical significance in the occurrence of CSH or RCH in location, size and multiplicity of aneurysm or the operative time required. RCH occurred in 4.4% of cases using inhalation anesthesia, and 7.2% in total intravenous anesthesia, respectively. There was no evidence of associated morbidity in any of the cases. CSH occurred predominantly in male patients over 65 years old. The risk of RCH was intraoperative draining of large volumes of CSF, total intravenous anesthesia with mannitol use and postoperative drainage of larger amounts of fluid. The results showed the importance of careful operative procedure and the effectiveness of arachnoid plasty in preventing CSH and RCH.

Remote Cerebellar Hemorrhage Complicated after Supratentorial Surgery: Retrospective Study with Review of Articles

Remote cerebellar hemorrhage (RCH) is one of the rare complications occurring after supratentorial surgery, and its pathomechanism is poorly understood. We report 10 cases of RCH from our institution and review 154 cases from a database in order to delineate incidence, common presentation, risk factors, and outcomes of this complication. In addition, the means of prevention are discussed. We reviewed the medical records of 10 patients who experienced RCH after undergoing supratentorial surgery at our institution between 2001 and 2008. A database search in Medline revealed 154 cases of RCH in the English literature. Characteristic features were analyzed and compared. There were 10 cases of RCH among 3307 supratentorial surgery cases, indicating a 0.3% incidence. All patients had characteristic imaging features of RCH, namely a streaky bleeding pattern in the superior folia of the cerebellum. Seven patients had a history of preoperative hypertension. Four cases were related to cerebral aneurysms, and other four developed after the removal of brain tumors. Cerebrospinal fluid (CSF) drainage apparatuses were installed postoperatively in all cases. Outcomes according to modified Rankin scale (mRS) were good in 7 patients, with 1 fatal case. RCH is a rare complication after supratentorial surgery, and the exact etiology still remains uncertain. Hypertension and perioperative loss of CSF seem positively correlated with RCH, but no single risk factor is totally responsible. Patients with RCH should be closely observed to improve their prognosis.

Remote Cerebellar Hemorrhage Following Thoracic Spinal Surgery -Case Report-

A 51-year-old man underwent surgery for ossification of the ligamentum flavum at the T9-T10 levels. Intraoperatively, the dura was opened unintentionally and a subcutaneous suction drain was placed. The patient complained of severe headache and nausea postoperatively. Brain computed tomography obtained 3 days after the surgery demonstrated remote cerebellar hemorrhage and hydrocephalus. Suboccipital decompression, C1 laminectomy, and ventriculostomy were performed and his symptoms subsided 2 months later. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur after any type of spinal surgery resulting in dural tear or intradural manipulation. Early diagnosis is particularly important for the treatment of remote cerebellar hemorrhage following spinal surgery.

Remote cerebellar hemorrhage following resection of a supratentorial tumor: a case report

Remote cerebellar hemorrhage after supratentorial surgery is rare, ranging between 0.08% and 0.29% in adults and children. However, it is extremely rare in children. This phenomenon underlying mechanisms remain obscure. A 14-year-old male child patient had a history of right focal seizures and underwent craniotomy for a left frontal mass (Dysembryoplastic Neuroepithelial Tumor). First hours post recovery period, the patient was somnolent and had right hemiparesis. Postoperative Computer Tomography and magnetic resonance imaging findings revealed that the patient had developed remote cerebellar hemorrhage. He was treated conservatively, and was free of neurological deficits.Although dehydration and the displacement of the cerebellum are associated with this phenomenon after supratentorial surgery, the identification of the exact etiological factors remains elusive. It is advisable for case givers to be aware of the high potential risk of morbidity and mortality of this entity. Preoperative attention to prevent cerebrospinal fluid overflow leakage and exaggerated dehydration of the patient may prevent remote cerebellar hemorrhages.

Remote Cerebellar Hemorrhage after Lumbar Spinal Surgery

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.

Cerebellar hemorrhage: as a rare complication of spinal surgery

Remote cerebellar hemorrhage (RCH) after spinal surgery is encountered extremely rarely. A 64 year-old female patient developed symptoms of deteriorating consciousness and diplopia arising on the first postoperative day after recurrent spinal surgery. Cranial CT scan showed cerebral edema and evidence of a cerebellar hemorrhage. Urgent suboccipital decompressive craniectomy and expanded duraplasty were performed. Repeat CT at 24 h revealed hydrocephalus and an external ventricular drain (EVD) was inserted for 20 days. The patient's consciousness deteriorated after withdrawal of the EVD and a ventriculoperitoneal shunt was placed. The patient recovered completely except for gait ataxia and left foot drop. Although the exact cause is unknown iatrogenic dural opening resulting in excessive cerebrospinal fluid (CSF) drainage and secondary development of venous infarction have been suggested to lead to RCH.

Remote cerebellar hemorrhage after lumbar spinal surgery

Background Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de dos casos y revisión de la literatura

Remote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.

Remote Cerebellar Haemorrhage after Spinal Surgery

Remote cerebellar haemorrhage (RCH) is a rare but potentially lethal complication of spinal surgery resulting from inadvertent opening of the dura. The precise mechanism of this type of haemorrhage remains undetermined. Magnetic resonance imaging (MRI) may show a ‘Zebra sign’ representing the horizontal curvilinear configuration of haemorrhage between the cerebellar folia.

Remote cerebellar hemorrhage after supratentorial unruptured aneurysmal surgery: report of three cases

We report three cases of remote cerebellar hemorrhage that developed after supratentorial unruptured aneurysmal surgery.In all cases, digital subtraction angiography was performed before each operation in order to rule out other vascular abnormalities, especially around the operative field or the posterior circulation. In addition, all patients were screened for any previous history of bleeding tendencies or other related medical disorders. Each patient underwent clipping surgery via the pterional approach. Remote cerebellar hemorrhage was identified on post-operative computed tomographic scans. In all cases, there was no evidence of significant associated long-term morbidity.A consideration of the possible pathophysiologic mechanisms underlying these post-operative remote cerebellar hemorrhages and suggested strategies for avoiding such complications are discussed.

Cerebellar haemorrhage after repeated burr hole evacuation for chronic subdural haematoma

We report a 79-year-old man whose third burr hole craniotomy evacuation for recurrent chronic subdural haematoma (CSDH) was complicated by cerebellar haemorrhage. The patient died 9 days later. Two previously documented cases in which this complication arose after evacuation of extra-axial collections also resulted in death. Remote cerebellar haemorrhage is a rare complication of neurosurgery but is associated with high mortality. This complication should be considered among the differential diagnoses after neurological deterioration following CSDH evacuation.

Remote cerebellar hemorrhage: A review

Remote cerebellar hemorrhage remains a complication rarely occurring after supratentorial surgery (<5%) and presumably even less frequent after spinal surgery. Although the pathomechanisms leading to RCH with its typical bleeding pattern are still not definitely understood, intra- or even more likely postoperative loss of larger volumes of CSF seem to be related to this complication. Prognosis significantly depends on severity of hemorrhage and patient age. Outcome in more than 50% of all cases is good with only mild remaining neurological symptoms or complete recovery, while death occurs in approximately 10-15%. Close monitoring of patients undergoing surgery that involves the risk of draining large volumes of CSF is mandatory and patients with postoperative drainage of larger amounts of fluid acquire increased attentiveness. Early detection and correct interpretation of the typical bleeding pattern might help to avoid further aggravation of symptoms. This review will address incidence, typical appearance and pathophysiological considerations, as well as risk factors, treatment options, and outcome related with RCH.

Cerebellar Hemorrhage Caused by Remote Neurological Surgery

Intracranial hemorrhage usually occurs as a complication of hypertension, coagulopathy, or trauma. In rare instances, remote cerebellar hemorrhage (RCH) may complicate supratentorial or spinal surgery. Retrospective case series study. We describe three cases of RCH complicating spinal and cranial surgical procedures associated with cerebrospinal fluid hypotension. Remote cerebellar intracranial hemorrhage may complicate neurosurgical procedures in which cerebrospinal fluid hypotension occurs.

Cerebellar hemorrhage after spinal surgery: case report and review of the literature

Recent reports indicate that cerebellar hemorrhage after spinal surgery is infrequent, but it is an important and preventable problem. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanisms are unknown. This report details the case of a 48-year-old woman who developed remote cerebellar hemorrhage after spinal surgery. The patient presented with a herniated lumbar disc, spinal stenosis, and spondylolisthesis, and underwent multiple-level laminectomy, discectomy, and transpedicular fixation. The dura mater was opened accidentally during the operation. There were no neurologic deficits in the early postoperative period; however, 12 h postsurgery the patient complained of headache. This became more severe, and developed progressive dysarthria and vomiting as well. Computed tomography demonstrated small sites of remote cerebellar hemorrhage in both cerebellar hemispheres. The patient was treated medically, and was discharged in good condition. At 6 months after surgery, she was neurologically normal. The case is discussed in relation to the ten previous cases of remote cerebellar hemorrhage documented in the literature. The only possible etiological factors identified in the reported case were opening of the dura and large-volume cerebrospinal fluid loss.

Remote Cerebellar Hemorrhage after a Spinal Surgery Complicated by Dural Tear: Case Report and Literature Review

This report presents a case in which cerebellar hemorrhage occurred after lumbar decompression surgery that was complicated by dural tear and prolonged cerebrospinal fluid leakage. Remote cerebellar hemorrhage after spinal surgery is extremely rare. Our objective is to describe this unusual complication, discuss the possible mechanisms of remote cerebellar hemorrhage, and review the literature. A 73-year-old woman underwent surgery for lumbar spinal stenosis. A dural tear occurred during decompression, and the patient developed remote cerebellar hemorrhage on postoperative Day 2. The cerebellar hemorrhage was treated surgically, and a biopsy of hemorrhagic brain parenchyma revealed an arteriovenous malformation. Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss

Supratentorial subdural hematoma is a well-known complication following spinal interventions. Less often, spinal or supratentorial interventions cause remote cerebellar hemorrhage (RCH). The exact pathomechanism accounting for RCH remains unclear, but an interventional or postinterventional loss of cerebrospinal fluid (CSF) seems to be involved in almost all cases. Hemorrhage is often characterized by a typical, streaky bleeding pattern due to blood spreading in the cerebellar sulci. Three different cases featuring this bleeding pattern following spinal, supratentorial, and thoracic surgery are presented. Possible pathomechanisms leading to RCH are discussed. Based on data from the underlying cases and the reviewed literature, the authors concluded that this zebra-pattern hemorrhage seems to be typical in a postoperative loss of CSF, which should always be considered on presentation of this bleeding pattern.