Cerebellar Hemorrhage Caused by Remote Neurological Surgery

Chalela, Julio A.; Monroe, Timothy; Kelley, Maggie; Auler, Mark; Bryant, Tanya; Vandergrift, Alexander; Bailey, Byron J.; Rumbold, Zoran

doi:10.1385/ncc:5:1:30

Cited by 20 publications

(11 citation statements)

References 9 publications

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“…4 The presence of this so-called "zebra sign" has been confirmed and reported in several subsequent papers. 6,8,10,17 A similar bleeding pattern has also been found in cases of CBH after supratentorial durotomy, suggesting a shared mechanism of acute CSF loss after dural opening leads to cerebellar herniation and tearing of cerebellar bridging veins. Physicians are therefore advised to relate this unique pattern of hemorrhage to a prior or ongoing loss of CSF.…”

supporting

confidence: 56%

Intracranial hemorrhage after spine surgery

Kaloostian

Kim

Bydon

et al. 2013

SPI

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Object. The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome.Methods. The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery.Results. The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period.Conclusions. Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome. (http://thejns.org/doi/abs/10.3171/2013.6.SPINE12863) KEy WorDs • intracranial hemorrhage • spine surgery • cerebrospinal fluid leakAbbreviations used in this paper: CBH = cerebellar hemorrhage; ICH = intracranial hemorrhage; IVH = intraventricular hemorrhage; SAH = subarachnoid hemorrhage; SDH = subdural hemorrhage.

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supporting

confidence: 56%

Intracranial hemorrhage after spine surgery

Kaloostian

Kim

Bydon

et al. 2013

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“…Since then, eight more cases of patients with cerebellar haematoma after spinal operations have been published [5 (2 cases), 7,8,12,14,20,21].…”

Section: Discussionmentioning

confidence: 99%

Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms

Hempelmann¹,

Mater²

2012

Eur Spine J

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Introduction Intracranial haemorrhage is a rare complication of spinal surgery. Three cases of cerebral or cerebellar haemorrhages following spinal operations with CSF loss are reported, and the literature was reviewed. Case presentations One patient suffered from melancholy after the operation, one patient had moderate headache and nausea, and the third patient suffered from mental confusion and anxiety. The intracranial haemorrhages were treated conservatively. All patients recovered from the bleedings. Results The cases show that cerebral or cerebellar haemorrhage after spinal CSF loss may be accompanied by minor or rather untypical clinical symptoms. Conclusion The dangerous complication of intracranial haemorrhage has to be kept in mind when patients have moderate cerebral symptoms after CSF loss due to spinal operations.

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“…1,[3][4][5][6][7][8][9][10][11][12]14,15) The exact pathophysiological mechanism of remote cerebellar hemorrhage is unknown, but a venous origin and intra-or postoperative CSF loss may be involved. 2) During spinal surgery, the dura mater was opened in all cases (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Remote Cerebellar Hemorrhage Following Thoracic Spinal Surgery -Case Report-

Morofuji

Tsunoda

Takeshita

et al. 2009

Neurol. Med. Chir.(Tokyo)

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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.

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Cerebellar Hemorrhage Caused by Remote Neurological Surgery

Abstract: Remote cerebellar intracranial hemorrhage may complicate neurosurgical procedures in which cerebrospinal fluid hypotension occurs.

Cited by 20 publications

References 9 publications

Intracranial hemorrhage after spine surgery

Intracranial hemorrhage after spine surgery

Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms

Remote Cerebellar Hemorrhage Following Thoracic Spinal Surgery -Case Report-

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