Remote cerebellar haemorrhage after lumbar spine surgery: case report

Abstract

Remote cerebellar haemorrhage (RCH) is a well-described complication of supratentorial surgical procedures with an incidence ranging between 0.2 and 4.9 %, but is a rare complication of spinal surgery. We report a case of RCH in a 65-year-old woman who showed sudden mental deterioration 48 h after lumbar spinal surgery, which was complicated by incidental dural tearing with minimal CSF loss. Brain CT scan revealed hypodense areas compatible with acute infarction involving mostly the left cerebellar hemisphere. No cerebral bleeding was observed. MRI was also performed revealing small cerebellar areas of acute infarction mainly relating the vermis and the left postero-inferior cerebellar hemisphere with haemorrhagic transformation and mass effect in the posterior fossa producing acute hydrocephalus. Haematoma removal was initially attempted by means of a suboccipital craniotomy. An external ventricular derivation was placed in a second procedure 24 h later due to the persistence of ventricular dilatation. At discharge the patient was only showing a slight dysmetria with the fine motor skills of hands and fingers. All cases of RCH after spinal surgery reported in the literature are invariably associated to iatrogenic dural tearing; although CSF loss seems to play the key role in the pathogenesis of this rare complication, the exact pathophysiology of this condition still remains undetermined.

Bilateral remote cerebellar haemorrhage after spinal surgery: A case study and review of the literature

“…Furthermore, one can expect that a mechanical stress, like that of cerebellar sagging, may produce a suffering of superficial tissues rather than an obstruction/lesion of a specific gross artery or vein. However, cerebellar ischaemic infarction and subsequent haemorrhagic transformation may be the cause of RCH in sporadic cases [32]. In such cases, if a CT or MRI scan is performed the location of the haemorrhage is more likely to be intraparenchymal rather than subarachnoid.…”

Remote Cerebellar Hemorrhage after Surgery for Spinal Column Tumor: An Unusual Cause of Impaired Consciousness

“…Other cases that develop mass effect in this region should be driven more aggressively, with surgical removal of the lesion. 1,3,[9][10][11][12] …”

Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery : An Unusual Case Report

“…According to one series, the prevalence of asymptomatic RCH was 0.8%5). The rate of asymptomatic cases is higher be cause imaging is carried out only in patients with symptoms2,5).…”