J Cerebrovasc Endovasc Neurosurg.  2022 Sep;24(3):276-280. 10.7461/jcen.2022.E2021.08.005.

Remote cerebellar hemorrhage after a neurosurgical procedure: A report of three cases

• Lee W
• Kim T
• Kim H
• Kim JE
• Baek KH
• Koh EJ
• Kim KH
• Ha EJ

• KMID: 2533680
• DOI: http://doi.org/10.7461/jcen.2022.E2021.08.005

Abstract

Remote cerebellar hemorrhage (RCH) is a rare complication of neurosurgical procedures and is characterized by a typical bleeding pattern defined as the “zebra sign.” Only few cases of RCH have been reported in the English literature, and its pathophysiology remains unclear. In this report, we present the cases of three patients with RCH after three different procedures: burr-hole trephination and chronic subdural hematoma evacuation of bilateral cerebral convexity with subsequent subdural drain insertion, lumbar drainage for cerebrospinal fluid divergence for thoracic endovascular aortic repair, and combined bypass surgery for moyamoya disease.

Keyword

Remote cerebellar hemorrhage; Complication; Cerebrospinal fluid; Intracranial pressure; Zebra sign; Neurosurgical procedure

Figure

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  Fig. 1. (A, B) Preoperative brain CT demonstrating bilateral subdural hemorrhage. (C, D) Immediate postoperative brain CT showing pneumocephalus with the Mt. Fuji sign. No lesions were observed in the cerebellum. (E, F) Follow-up brain CT showing newly emerged cerebellar hemorrhage. CT, computed tomography

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  Fig. 2. (A, B) Brain MRI showing bilateral cerebellar hemorrhage with brainstem compression. (C, D) Follow-up CT demonstrating aggravated acute obstructive hydrocephalus. MRI, magnetic resonance imaging; CT, computed tomography

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  Fig. 3. (A) Immediate postoperative brain CT showing usual postoperative findings. (B) Brain CT (3 h after the previous CT) demonstrating remote cerebellar hemorrhage. CT, computed tomography

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