J Cerebrovasc Endovasc Neurosurg.  2021 Mar;23(1):49-53. 10.7461/jcen.2020.E2020.08.006.

Remote cerebellar hemorrhage following surgical clipping of an unruptured cerebral aneurysm of the middle cerebral artery

• Lee IH
• Choi J

• KMID: 2514338
• DOI: http://doi.org/10.7461/jcen.2020.E2020.08.006

Abstract

An infrequent complication, remote cerebellar hemorrhage (RCH) may occur after supratentorial craniotomy at a reported incidence of 0.08-0.6%. Although RCH is mostly self limiting, early diagnosis and treatment are necessary as the condition may result in severe neurologic deficits or mortality. Because RCH is often asymptomatic, occurrence of it was occasionally recognized with brain computed tomography (CT) scans only. We experienced two contrasting cases of RCH in patients with unruptured cerebral aneurysms of the middle cerebral artery. These cases indicate that it should be mandatory to perform a brain CT scans immediately after surgery and on appropriate time to detect RCH. Awareness of this complication and close monitoring are essential for avoiding fatal neurological deficits or mortality.

Keyword

‌CSF drainage; Remote cerebellar hemorrhage; Supratentorial craniotomy; Unruptured intracranial aneurysm; Zebra sign

Figure

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  Fig. 1. (A) Brain magnetic resonance angiography scans showing an unruptured cerebral aneurysm of the right middle cerebral artery. (B) Immediate postoperative non-contrast-enhanced computed tomography (CT) scans revealing subarachnoid hemorrhage in the cerebellar sulci with hemorrhage in the fourth ventricle after aneurysmal clipping. (C) Follow-up CT scans showing a recovery from the remote cerebellar hemorrhage with effacement of the fourth ventricle on postoperative day 13.

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  Fig. 2. (A) Unruptured cerebral aneurysm at the bifurcation of the right middle cerebral artery on cerebral angiography. (B) The immediate postoperative non-contrast-enhanced computed tomography (CT) scans after aneurysmal clipping. (C) Immediate postoperative brain CT scans showing bilateral RCH accompanied by bilateral cerebellar edema. (D) Follow-up brain CT scans taken at six hours postoperatively revealing an increased amount of acute intracranial hemorrhage in both cerebellar hemispheres. RCH, remote cerebellar hemorrhage.

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