Chronic subdural hematoma of the posterior fossa associated with cerebellar hemorrhage: report of rare disease with MRI findings

Abstract

-Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 yearold woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.KEY WORDS: intracranial hematoma, subdural hematoma, posterior fossa.Hematoma subdural crônico de fossa posterior associado a hemorragia cerebelar espontânea: relato de doença rara com achados de RNM RESUMO -Hematomas subdurais da fossa posterior são lesões raras, mais comumente relacionadas com traumas graves. A ocorrência de hematomas subdurais crônicos na fossa posterior é muito rara, sendo descritos 15 casos até o momento, boa parte relacionada ao uso de anticoagulantes. Em nossa revisão da literatura, não pudemos encontrar nenhum relato da associação entre hematoma subdural crônico da fossa posterior e hemorragia cerebelar espontânea. Relatamos o caso de paciente de 64 anos com hematoma intraparenquimatoso cerebelar tratado conservadoramente e hematoma subdural crônico, tratado cirurgicamente, cerca de 1 mês após o acidente vascular cerebelar. PALAVRAS-CHAVE: fossa posterior, hematoma subdural, hematoma intracraniano.Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case in a woman. CASEA 64-year-old hypertensive woman presented to another emergency service 15 days before admission to our hospital with a history of sudden headache and gait disturbance. Her hypertension was well controlled with regularly taken antihypertensive medications. She was submitted to a CT scan of the head and treated conservatively with diagnosis of spontaneous cerebellar hemorrhage, and discharged five days after without intercurrences. Fifteen days later, she presented to our outpatient clinic with complaints of continuous headache, somnolence and urinary incontinence. Another CT scan was performed and showed hydrocephalus, and a ventriculoperitoneal shunt was inserted (Fig 1). On the first postoperative day, the patient presented with somnolence, slurred speech, incoordination and ataxia. A MRI (Figs 2 and 3) showed a right posterior fossa extra-axial hematoma, hyperintense both on T1 and T2 sequences, compressing the right cerebellar hemisphere, and a small, contiguous, intraparenchymal right cerebellar hematoma in subacute fase, with some edema; MRI angiography was normal. The patient was taken to the operating room. A suboccipital right craniectomy ...

Bilateral Chronic Subdural Hematomas of the Posterior Fossae

“…5) Only 10 cases have been reported since the introduction of CT (Table 1). 1,2,6,[11][12][13]16,18) These reports highlight the rarity, 1,12,13) the developmental mechanism, 6,18) or the difficulty of diagnosis. 2,11,16) In general, burr-hole surgery or twist-drill craniostomy over the skull convexity under local anesthesia and slight sedation is often performed for symptomatic supra- …”

“…1,2,4,6,[11][12][13]16,18) Burr-hole evacuation and irrigation with or without closed-system drainage has been widely accepted as the optimum method to treat supratentorial CSH, 3,8,14,15,17,19) but the optimal therapeutic strategy for CSH of the posterior fossa is still controversial. Here, we present a case of bilateral CSHs located in the posterior fossae which were successfully treated by posterior fossa trepanation and evacuation of the hematomas.…”

“…1,2,6,12,13,16,18) For example, some cases of unilateral CSH of the posterior fossa were treated with lateral suboccipital craniectomy. However, there are no detailed records of the operative procedure in these reports.…”

“…Previous cases have not discussed the requirements of anesthesia. 1,2,6,[11][12][13]18) However, we considered that general anesthesia is needed for to perform safe surgery of both unilateral and bilateral CSHs of the posterior fossa. This is the most significant difference from surgery for supratentorial CSH.…”

Subdural Hematoma of the Brainstem in a Dog: Magnetic Resonance Findings and Treatment

“…Subdural hematomas in people are common neurosurgical lesions with an incidence rate of one to two occurrences per 100,000 cases per year, and they are often associated with traumatic head injury. 32,33 However, subdural hematomas of the posterior fossa are very rare in adults. 32,34 The rarity of posterior fossa subdural hematomas in people is probably related to the small number of bridging veins in the posterior fossa in comparison with the supratentorial subdural space.…”