Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Remote Cerebral and Cerebellar Hemorrhage after Massive Cerebrospinal Fluid Leakage

  • You, Sung-Hye (Department of Radiology, Korea University Anam Hospital) ;
  • Son, Kyu-Ri (Department of Radiology, Korea University Anam Hospital) ;
  • Lee, Nam-Joon (Department of Radiology, Korea University Anam Hospital) ;
  • Suh, Jung-Keun (Department of Neurosurgery, Korea University Anam Hospital)
  • Received : 2011.08.05
  • Accepted : 2012.04.17
  • Published : 2012.04.28
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Abstract

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.

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References

  1. Amini A, Osborn AG, McCall TD, Couldwell WT : Remote cerebellar hemorrhage. AJNR Am J Neuroradiol 27 : 387-390, 2006
  2. Andrews RT, Koci TM : Cerebellar herniation and infarction as a complication of an occult postoperative lumbar dural defect. AJNR Am J Neuroradiol 16 : 1312-1315, 1995
  3. Bowers CA, Taussky P, Duhon BS, Schmidt MH : Multiple supra- and infratentorial intraparenchymal hemorrhages presenting with seizure after massive sacral cerebrospinal fluid drainage. Spine (Phila Pa 1976) 36 : E288-E291, 2011 https://doi.org/10.1097/BRS.0b013e3181f9b10f
  4. Brockmann MA, Groden C : Remote cerebellar hemorrhage : a review. Cerebellum 5 : 64-68, 2006 https://doi.org/10.1080/14734220500521032
  5. Brockmann MA, Nowak G, Reusche E, Russlies M, Petersen D : Zebra sign : cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report. J Neurosurg 102 : 1159-1162, 2005 https://doi.org/10.3171/jns.2005.102.6.1159
  6. Friedman JA, Ecker RD, Piepgras DG, Duke DA : Cerebellar hemorrhage after spinal surgery : report of two cases and literature review. Neurosurgery 50 : 1361-1363; discussion 1363-1364, 2002
  7. Hashidate H, Kamimura M, Nakagawa H, Takahara K, Uchiyama S, Kato H : Cerebellar hemorrhage after spine surgery. J Orthop Sci 13 : 150-154, 2008 https://doi.org/10.1007/s00776-007-1199-x
  8. 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 96 : 248-254, 2002 https://doi.org/10.3171/jns.2002.96.2.0248
  9. König A, Laas R, Herrmann HD : Cerebellar haemorrhage as a complication after supratentorial craniotomy. Acta Neurochir (Wien) 88 : 104-108, 1987 https://doi.org/10.1007/BF01404145
  10. Konya D, Ozgen S, Pamir MN : Cerebellar hemorrhage after spinal surgery : case report and review of the literature. Eur Spine J 15 : 95-99, 2006 https://doi.org/10.1007/s00586-005-0987-2
  11. Morandi X, Riffaud L, Carsin-Nicol B, Guegan Y : Intracerebral hemorrhage complicating cervical "hourglass" schwannoma removal. Case report. J Neurosurg 94 : 150-153, 2001
  12. Nam TK, Park SW, Min BK, Hwang SN : Remote cerebellar hemorrhage after lumbar spinal surgery. J Korean Neurosurg Soc 46 : 501-504, 2009 https://doi.org/10.3340/jkns.2009.46.5.501
  13. Thomas G, Jayaram H, Cudlip S, Powell M : Supratentorial and infratentorial intraparenchymal hemorrhage secondary to intracranial CSF hypotension following spinal surgery. Spine (Phila Pa 1976) 27 : E410-E412, 2002 https://doi.org/10.1097/00007632-200209150-00023
  14. Yoshida S, Yonekawa Y, Yamashita K, Ihara I, Morooka Y : Cerebellar hemorrhage after supratentorial craniotomy--report of three cases. Neurol Med Chir (Tokyo) 30 : 738-743, 1990 https://doi.org/10.2176/nmc.30.738

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