J Korean Neurosurg Soc.  2017 May;60(3):367-370. 10.3340/jkns.2014.0709.001.

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

• Sen HM
• Guven M
• Aras AB
• Cosar M

• KMID: 2382773
• DOI: http://doi.org/10.3340/jkns.2014.0709.001

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.

Keyword

Cerebellum; Hemorrhage; Mutism; Spine

MeSH Terms

Adult
Cerebellum
Cerebrospinal Fluid
Child
Female
Hemorrhage*
Humans
Incidence
Infarction
Mutism*
Spine

Figure

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  Fig. 1 A bilateral cerebellar hemorrhage (zebra sign), frontal and suprasellar pneumocephalus, and slight ventricular dilatation observed on postoperative CT: computerized tomography.

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  Fig. 2 Follow-up CT performed 2 months after the surgery showing no hemorrhage and a reduction in the ventricular size to a normal level. CT: computerized tomography.

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  Fig. 3 Follow-up MRI performed 12 days after the surgery showing a bilateral hyperintense cerebellar lesion in accordance with a hemorrhage and slight ventricular dilatation. A: Axial T1-weighted image. B: Axial T2-weighted image. C: Coronal T2-weighted image. D: Sagittal T1-weighted image. MRI: magnetic resonance imaging.

Reference

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