Bilateral remote cerebellar hemorrhage following surgical clipping a ruptured supratentorial aneurysm

Shan-jun, Wang; Liu, Xiaogang; Wang, Fachen; Yuan, Xunhui; Qiu, Shaobo; Guo, Liemei

doi:10.1080/02688697.2018.1426723

Cited by 5 publications

(1 citation statement)

References 5 publications

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“…Therefore, to improve the success rate of treatment of RCH and reduce the rate of death and disability of RCH, it is necessary to analyze and summarize the experience of RCH-related cases; explore the pathogenesis of RCH; and promote the prevention, diagnosis, and treatment of RCH. Supratentorial craniotomy related to RCH has been reported, including aneurysm clipping, 3 , 4 tumor resection, 5 , 6 hydrocephalus surgery, 7 and transcranial pituitary surgery. 8 In our cases, RCH in case 4 occurred after meningioma resection, and the other 3 cases all occurred after aneurysm clipping.…”

Section: Discussionmentioning

confidence: 99%

Remote cerebellar hemorrhage after supratentorial craniotomy: illustrative cases

Liu

Yang

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Remote cerebellar hemorrhage (RCH) is an extremely rare and potentially fatal complication after supratentorial craniotomy. However, the exact pathophysiological mechanism of RCH remains unclear, so clinicians often lack clinical experience in prevention, early diagnosis, and standardized treatment. OBSERVATIONS The authors retrospectively analyzed data of patients who underwent surgery for supratentorial lesions at their center between 2012 and 2021. They identified 4 patients who developed RCH among 4,075 patients who underwent supratentorial craniotomy. All 4 patients were male, with an average age of 57.5 years. One RCH occurred after tumor resection, and the other 3 occurred after aneurysm clipping. One patient was asymptomatic and received conservative treatment with a favorable outcome. The remaining 3 patients underwent lateral ventricular drainage and/or suboccipital decompression; 2 died, and 1 recovered well. LESSONS The authors believe that RCH should be considered as a multifactorial cause, and massive cerebrospinal fluid loss plays a key role in the development and progression of RCH. Asymptomatic RCH can be treated conservatively. However, in the case of conscious disturbance, hydrocephalus, and brain stem compression, surgery should be performed immediately. Early detection and individualized treatment would be helpful to avoid potentially fatal outcomes caused by RCH.

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Section: Discussionmentioning

confidence: 99%

Remote cerebellar hemorrhage after supratentorial craniotomy: illustrative cases

Liu

Yang

et al. 2022

Journal of Neurosurgery: Case Lessons

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Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke

Frol,

Pretnar Oblak,

Šabovič

et al. 2024

Clin Appl Thromb Hemost

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Direct oral anticoagulants (DOACs) changed stroke prevention and decreased the risk of ischemic and hemorrhagic complications in patients on oral anticoagulation (OAC) therapy. The numbers of patients prescribed DOACs has increased rapidly. Availability of specific reversal agents opened new avenues in the prevention and management of DOAC complications. An ideal specific reversal agent for a DOAC in acute stroke is an agent which lacks safety concerns and immediately reverses DOAC anticoagulation activity, thereby enabling effective treatment. Reversal of anticoagulant activity is mandatory in patients with acute ischemic stroke (AIS) before performing therapeutic procedures such as intravenous thrombolysis (IVT) and neurosurgery in intracranial hemorrhage (ICH) in order to improve clinical outcomes. In this manuscript we pursue an interdisciplinary approach in discussing advantages and concerns of specific reversal agents in acute stroke DOAC-treated patients in everyday clinical practice.

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Remote cerebellar hemorrhage following repeated lumbar punctures

Wang

Han

et al. 2023

BMC Neurol

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Background Remote cerebellar hemorrhage (RCH) is a rare complication in neurosurgery. No case of RCH secondary to repeated lumbar punctures (LPs) has been previously reported. Case presentation A 49-year-old man presented with impaired consciousness following persistent fever. Cerebrospinal fluid examination showed high opening pressure, elevated white blood cells, increased protein level, and decreased glucose level, resulting in a diagnosis of bacterial meningoencephalitis. Treatment with repeated LPs and intrathecal injection of ceftriaxone resulted in an improvement in neurological symptoms. However, on day 31 of treatment, brain magnetic resonance image (MRI) showed streaky bleeding in bilateral cerebellum (zebra sign), leading to a diagnosis of RCH. Close observation and repeated brain MRI imaging without specific treatments led to the absorption of bilateral cerebellar hemorrhage, and the patient was discharged with improved neurological symptoms. Repeated brain MRI scans one month after discharge showed that bilateral cerebellar hemorrhage had improved, and had disappeared one year after discharge. Conclusion We reported a rare occurrence of LPs-induced RCH presenting as isolated bilateral inferior cerebellar hemorrhage. Clinicians should be vigilant of the risk factors for RCH, closely monitoring patients' clinical symptoms and neuroimaging findings to determine the need for specialized treatment. Furthermore, this case highlights the importance of ensuring the safety of LPs and managing any potential complications appropriately.

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Bilateral remote cerebellar hemorrhage following surgical clipping a ruptured supratentorial aneurysm

Cited by 5 publications

References 5 publications

Remote cerebellar hemorrhage after supratentorial craniotomy: illustrative cases

Remote cerebellar hemorrhage after supratentorial craniotomy: illustrative cases

Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke

Remote cerebellar hemorrhage following repeated lumbar punctures

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