Korean J Neurotrauma.  2015 Oct;11(2):201-204. 10.13004/kjnt.2015.11.2.201.

Remote Cerebellar Hemorrhage after Surgery for Degenerative Lumbar Spine Disease: A Case Report

Affiliations
  • 1Department of Neurosurgery, Inha University College of Medicine, Inha University Hospital, Incheon, Korea. nsyoon@gmail.com

Abstract

Spine surgery has been increased as the population ages, but the occurrence of unusual complication such as remote cerebellar hemorrhage (RCH) is not well understood. We recently experienced a case of RCH in a 60-year-old woman showed neurologic dysfunction after degenerative lumbar spine surgery. There was no definite dural tearing and cerebrospinal fluid (CSF) loss during operation. Brain magnetic resonance imaging showed cerebellar hemorrhage. The patient received conservative management and rehabilitation program. Most other reports have been suggested that RCH after spinal surgery might be related with excessive CSF drainage perioperatively. Minimizing of CSF loss during operation would be helpful to reduce the risk of RCH. If large volume of CSF has been lost accompanied by neurologic deterioration, brain imaging is necessary simultaneously.

Keyword

Cerebellar disease; Intracranial hemorrhage; Lumbar vertebrae surgery; Dura mater injury; Cerebrospinal fluid; Postoperative complication

MeSH Terms

Brain
Cerebellar Diseases
Cerebrospinal Fluid
Drainage
Female
Hemorrhage*
Humans
Intracranial Hemorrhages
Magnetic Resonance Imaging
Middle Aged
Neuroimaging
Neurologic Manifestations
Postoperative Complications
Rehabilitation
Spine*
Tears

Figure

  • FIGURE 1 A, B: The lumbar spine magnetic resonance imaging shows lumbarization of the S1 vertebra, degenerative spondylolisthesis at L4/5 and retrolisthesis at L5/S1.

  • FIGURE 2 Postoperative X-ray (A, B) shows a laminectomy on L4 and L5, with instrumentation from L3 to S1.

  • FIGURE 3 Axial plane images of the gradient recalled echo sequence (A) revealed a subacute cerebellar hemorrhage postoperatively. Evidence of an infarction or vascular abnormality could not be found on the magnetic resonance angiography (B).


Reference

1. Adam R, Priglinger M, Harrington T, Gottlieb D, Krause M. An unusual cause of cerebellar hemorrhage in a young patient: essential thrombocythemia. J Stroke Cerebrovasc Dis. 2014; 23:e373–e374. PMID: 24582788.
Article
2. Brockmann MA, Groden C. Remote cerebellar hemorrhage: a review. Cerebellum. 2006; 5:64–68. PMID: 16527766.
Article
3. Brockmann MA, Nowak G, Reusche E, Russlies M, Petersen D. Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report. J Neurosurg. 2005; 102:1159–1162. PMID: 16028781.
4. Calisaneller T, Yilmaz C, Ozger O, Caner H, Altinors N. Remote cerebellar haemorrhage after spinal surgery. Can J Neurol Sci. 2007; 34:483–484. PMID: 18062460.
Article
5. Cavanilles-Walker JM, Tomasi SO, Sgier F, Kröber M. Remote cerebellar haemorrhage after lumbar spine surgery: case report. Arch Orthop Trauma Surg. 2013; 133:1645–1648. PMID: 24121622.
Article
6. Cevik B, Kirbas I, Cakir B, Akin K, Teksam M. Remote cerebellar hemorrhage after lumbar spinal surgery. Eur J Radiol. 2009; 70:7–9. PMID: 18294795.
Article
7. Chadduck WM. Cerebellar hemorrhage complicating cervical laminectomy. Neurosurgery. 1981; 9:185–189. PMID: 7266820.
Article
8. Farag E, Abdou A, Riad I, Borsellino SR, Schubert A. Cerebellar hemorrhage caused by cerebrospinal fluid leak after spine surgery. Anesth Analg. 2005; 100:545–546. PMID: 15673890.
Article
9. Friedman JA, Ecker RD, Piepgras DG, Duke DA. Cerebellar hemorrhage after spinal surgery: report of two cases and literature review. Neurosurgery. 2002; 50:1361–1363. discussion 1363-1364PMID: 12015857.
Article
10. Honegger J, Zentner J, Spreer J, Carmona H, Schulze-Bonhage A. Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery: a retrospective study. J Neurosurg. 2002; 96:248–254. PMID: 11838798.
11. Khalatbari MR, Khalatbari I, Moharamzad Y. Intracranial hemorrhage following lumbar spine surgery. Eur Spine J. 2012; 21:2091–2096. PMID: 22349967.
Article
12. Khong P, Jerry Day M. Spontaneous cerebellar haemorrhage following lumbar fusion. J Clin Neurosci. 2009; 16:1673–1675. PMID: 19793659.
Article
13. Konya D, Ozgen S, Pamir MN. Cerebellar hemorrhage after spinal surgery: case report and review of the literature. Eur Spine J. 2006; 15:95–99. PMID: 16007466.
Article
14. Mallio CA, Sarà M, Pistoia ML, Occhicone F, Errante Y, Giona A, et al. Bilateral remote cerebellar haemorrhage after spinal surgery: a case study and review of the literature. Brain Inj. 2014; 28:1216–1222. PMID: 24865277.
Article
15. Nam TK, Park SW, Min BK, Hwang SN. Remote cerebellar hemorrhage after lumbar spinal surgery. J Korean Neurosurg Soc. 2009; 46:501–504. PMID: 20041065.
Article
Full Text Links
  • KJN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr