Remote Cerebellar Hemorrhage after Spinal Surgery

Kim, Do Keun; Park, Chong Oon; Yoon, Seung Hwan; Cha, Dong‐Hyun

doi:10.13004/jknts.2010.6.2.162

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…37 In one case reported of remote ICH after spinal surgery, Kim et al described the presence of venous oozing below the tentorium without any specific arterial bleeding source. 17 Such findings support this sagmodel hypothesis, in which a decrease in CSF volume or pressure causes the brain to descend, resulting in stretching and therefore tearing of the cerebral and cerebellar veins. 3,6,7,11,15,35,37 Further neurological decline may occur through caudal displacement of the cerebellum with brainstem compression and development of cranial neuropathies, as described by Gul et al…”

Section: Discussionsupporting

confidence: 54%

“…4 The presence of this so-called "zebra sign" has been confirmed and reported in several subsequent papers. 6,8,10,17 A similar bleeding pattern has also been found in cases of CBH after supratentorial durotomy, suggesting a shared mechanism of acute CSF loss after dural opening leads to cerebellar herniation and tearing of cerebellar bridging veins. Physicians are therefore advised to relate this unique pattern of hemorrhage to a prior or ongoing loss of CSF.…”

supporting

confidence: 55%

“…Thus, ICH must be included in the differential diagnosis for postoperative confusion and declining mental status after spinal surgery, with opioid reversal being a possible option to ensure accurate diagnosis. 7,9,10,17,26 Computed tomography scanning can reveal a characteristic bleeding pattern in cases of postoperative remote CBH. Whereas hypertensive cerebellar hematomas are generally found near the dentate nucleus, remote CBHs are localized subcortically.…”

mentioning

confidence: 99%

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Intracranial hemorrhage after spine surgery

Kaloostian

Kim

Bydon

et al. 2013

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Object. The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome.Methods. The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery.Results. The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period.Conclusions. Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome. (http://thejns.org/doi/abs/10.3171/2013.6.SPINE12863) KEy WorDs • intracranial hemorrhage • spine surgery • cerebrospinal fluid leakAbbreviations used in this paper: CBH = cerebellar hemorrhage; ICH = intracranial hemorrhage; IVH = intraventricular hemorrhage; SAH = subarachnoid hemorrhage; SDH = subdural hemorrhage.

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Section: Discussionsupporting

confidence: 54%

supporting

confidence: 55%

mentioning

confidence: 99%

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Intracranial hemorrhage after spine surgery

Kaloostian

Kim

Bydon

et al. 2013

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“…Cerebellar hemorrhage (CBH) accounts for the vast majority of postoperative intracranial hemorrhage [ 1 , 9 , 10 ]. Other forms of postoperative bleeding include intracerebral hemorrhage (ICH) [ 2 , 4 , 11 ], subdural hemorrhage (SDH) [ 12 , 13 ], SAH [ 14 ], and IVH [ 8 , 12 , 15 – 17 ]. Depending on the location of the hemorrhage, patients may present with altered level of consciousness, headache, nausea, vomiting, dysarthria, ataxia, and motor or sensory deficits [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Basal ganglia hemorrhage in a case report following spinal surgery

et al. 2018

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BackgroundIntracranial hemorrhage is a rare but potentially severe complication of spinal surgery. Most reported post-operative ICH cases consist of cerebellar hemorrhage. There are fewer reported cases of supratentorial ICH following spinal surgery.Case presentationA 56-year-old woman underwent spinal surgery complicated by bilateral supratentorial intraparenchymal basal ganglia hemorrhage with both intraventricular extension and subarachnoid hemorrhage in both cerebral hemispheres.ConclusionThe occurrence of neurological deterioration post-operatively following spinal surgery should alert physicians to the possibility of intracranial hemorrhage in order to facilitate rapid and optimal management. To our knowledge, this is the first case reporting basal ganglia hemorrhage following spinal surgery. Moreover, consideration should be given to the possibility of this complication prior to recommendation of elective spinal surgery.

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“…The author suggested that the pressure gradient between the intravascular pressure and CSF pressure can be increased in a sitting position, followed by displacing the elongation of the brain and vasculature, which may contribute to the development of bleeding. 7 Article published in the latest European Spine Journal in 2012 suggests that the RCH is probably a manifestation of venous hemorrhage and cerebellar infarction, and result of excessive leakage of CSF, causing stretching and occlusion of the superior vermian veins. Patients with insufficient collateral veins may get venous infarction and subsequent hemorrhagic transformation.…”

Section: Discussionmentioning

confidence: 99%