J Korean Neurosurg Soc.  2012 Apr;51(4):240-243. 10.3340/jkns.2012.51.4.240.

Remote Cerebral and Cerebellar Hemorrhage after Massive Cerebrospinal Fluid Leakage

• You SH
• Son KR
• Lee NJ
• Suh JK

• KMID: 2066920
• DOI: http://doi.org/10.3340/jkns.2012.51.4.240

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.

Keyword

Remote intracranial hemorrhage; Cerebrospinal fluid leakage; Spinal surgery

MeSH Terms

Brain
Diagnostic Imaging
Headache
Hemorrhage
Humans
Magnetic Resonance Imaging
Middle Aged
Neurologic Manifestations
Temporal Lobe

Figure

• 

  Fig. 1 Lumbar spine MRI scan taken four days after posterior lumbar and interbody fusion at L5-S1. Sagittal T2-weighted image shows a large amount of cerebrospinal fluid leakage (arrows) in the lumbosacral space.

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  Fig. 2 Brain MRI taken 16 days after spinal surgery shows small sites of acute and subacute hemorrhaging in the right temporal lobe (arrowheads) and both cerebellar hemispheres (arrows) on T1-weighted image (A), T2-weighted image (B), and FLAIR image (C).

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  Fig. 3 Non-contrast brain CT shows multifocal hemorrhage in the right temporal lobe (arrowhead) and both cerebellar hemispheres (arrows).

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