J Korean Soc Spine Surg.  2016 Mar;23(1):31-35. 10.4184/jkss.2016.23.1.31.

Remote Cerebellar Hemorrhage due to Cerebrospinal Fluid Leakage or Meningitis after Spinal Surgery: Case Report

• Ko SH
• Cha JR
• Kang HK
• Cho SD
• Jung KH
• Lee CC
• Yeom YS
• Kim SW

• KMID: 2161010
• DOI: http://doi.org/10.4184/jkss.2016.23.1.31

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To report a rare case of remote cerebellar hemorrhage (RCH) as a complication of spinal surgery. SUMMARY OF LITERATURE REVIEW: Remote cerebellar hemorrhage is rare but lethal as a complication of spinal surgery. Interestingly, dural tears and cerebrospinal fluid (CSF) leakage are reported in all published cases of RCH.
MATERIALS AND METHODS
A 67-year-old man had posterior lumbar decompression and posterolateral fusion for spinal stenosis at L4/5/S1. Intraoperatively, the dura was torn and there was a loss of CSF. The dural tear was sutured immediately in a water-tight manner. After surgery, the patient complained of headache and dizziness. On postoperative day 44, brain magnetic resonance imaging (MRI) showed meningeal enhancement suggesting meningitis. On postoperative day 54, brain computed tomography (CT) showed cerebellar edema and hemorrhage, and external ventricular derivation was performed.
RESULTS
The patient died.
CONCLUSIONS
Special attention should be paid to prevent dural damage during spinal surgery or minimize CSF leakage in the case of dural damage and tears during spinal surgery, and CT and MRI should be promptly performed for symptomatic patients.

Keyword

Complication; Spinal surgery; Remote cerebellar hemorrhage; Cerebrospinal fluid; Dural tear; Meningitis

MeSH Terms

Aged
Brain
Cerebrospinal Fluid*
Decompression
Dizziness
Edema
Headache
Hemorrhage*
Humans
Magnetic Resonance Imaging
Meningitis*
Spinal Stenosis
Tears

Figure

• 

  Fig. 1. Computed tomography (CT) findings for the brain: Moderate ventriculomegaly.

• 

  Fig. 2. Magnetic resonance imaging (MRI) findings for the brain (axial Gd-enhanced T1): Prominent enhancement of meninges and moderate ventriculomegaly.

• 

  Fig. 3. MRI findings for the lumbar spine (sagittal Gd-enhanced T1): Fluid collection at the laminectomy site and around the fix-ators.

• 

  Fig. 4. CT findings for the brain: Acute cerebellar hemorrhage with diffuse parenchymal swelling in both cerebellar hemi-spheres.

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