Cerebellar hemorrhage after spine fixation misdiagnosed as a complication of narcotics use -A case report-

Abstract

Cerebellar hemorrhage occurs mainly due to hypertension. Postoperative cerebellar hemorrhage is known to be associated frequently with frontotemporal craniotomy, but quite rare with spine operation. A 56-year-old female received spinal fixation due to continuous leg tingling sensation for since two years ago. Twenty-one hours after operation, she was disoriented and unresponsive to voice. Performed computed tomography showed both cerebellar hemorrhage. An emergency decompressive craniotomy was carried out to remove the hematoma. On the basis of this case, we reported this complications and reviewed related literature.

Remote cerebellar hemorrhage following thoracic spinal surgery of an intradural extramedullary tumor: a case report

“…However, in severe cases, emergency surgical intervention with ventricular drainage or posterior fossa craniotomy was needed. Cranial surgery was performed in 14 patients, nine of whom improved, and five died or had serious paresis after surgery [ 4 , 6 , 7 , 9 , 11 - 14 , 17 , 18 , 20 , 24 , 25 ].…”

“…(2009) [ 23 ] microdiscectomy LS 53, M 2 hours present conservative improved Yang et al . (2011) [ 24 ] PSF LS 56, F 21 hours unknown surgery ataxia and aphasia Hempelmann and Mater (2012) [ 10 ] IETR TS 61, F 7 days present conservative improved PSF LS 69, F 2 days present conservative improved PSF LS 62, F 1 day present conservative improved Khalatbari et al . (2012) [ 13 ] discectomy LS 53, M 8 hours present surgery improved laminectomy LS 75, M perioperative present surgery died Lee et al .…”

Remote cerebellar hemorrhage after unruptured cerebral aneurysm surgery: two cases report

“…Because the clinical manifestation is asymptomatic in almost one quarter of reported cases [ 9 ], RCH occurrence was only recognized with brain CT scans in our cases even though the patients presented strange feelings upon eye blinking or delayed awakening. It is worth noting that an altered mental status because of RCH may be misdiagnosed as a narcotic effect of postoperative pain control [ 3 ].…”

“…The recognition of RCH occurring depends on unexpected neurologic disturbances and/or postoperative brain CT findings. Especially if the patient has been neurologically intact throughout the preoperative evaluation, neurologic symptoms and signs of RCH could be confused with other clinical situations such as the effects of postoperative pain control agents [ 3 ] or the effects of residual anesthetics. Modern neurosurgical anesthetic technique is designed to allow postoperative neurologic evaluation promptly using volatile anesthetic gas with low solubility and an ultra-short acting opioid; this requires considering postoperative pain control using opioids, even after a craniotomy.…”

“…Modern neurosurgical anesthetic technique is designed to allow postoperative neurologic evaluation promptly using volatile anesthetic gas with low solubility and an ultra-short acting opioid; this requires considering postoperative pain control using opioids, even after a craniotomy. Although many cases of RCH have been reported from a surgical viewpoints [ 4 , 5 ], there is one report of RCH from an anesthetic perspective after spine surgery [ 3 ]. In this article, we report two cases of RCH after surgical clipping of an unruptured cerebral aneurysm of the anterior communicating artery and review anesthetic considerations.…”