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

Abstract

Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has not been described. We describe the case of a 65-year old female who lost cerebrospinal fluid after inadvertent opening of the dura during surgery. Computerized tomography performed when the patient became unable to speak revealed a bilateral cerebellar hemorrhage.

Cerebellar Mutism Syndrome in Children and Adults

“…Between January 2011 and January 2018, six new instances of adult post-operative CMS (two vascular and five tumoral etiologies) were reported (De Smet and Mariën 2012;Damodaran et al 2013;Gündüz et al 2013;van Baarsen et al 2013;Mariën al. 2013a;Manzano-Lopez Gonzalez et al 2015), whereas two additional cases presented with CMS not induced by posterior fossa surgery (Mariën et al 2013b;Sen et al 2017).…”

A case report of seizure during emergence from general anesthesia after lumbar spinal surgery—common cases can develop potentially life-threatening adverse intracranial events

“…The incidence of dural injury during spinal surgery has been reported as 5.5 to 10.1% [5,7]. Dural injuries can cause intracranial hemorrhage [8,9] and even stroke and death [10]. Seizure is the one of the manifestation of intracranial events [1][2][3][4].…”