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

Ha, Sang Hee; Kim, Eun Mi; Ju, Hyang Mi; Lee, Woo Kyung; Min, Kyungha

doi:10.4097/kjae.2014.67.3.213

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…It is postulated that RCH is linked to an excessive intraoperative or postoperative CSF loss. [ 1 4 5 6 7 8 9 10 11 12 ] Due to CSF loss, the cerebellum is displaced downwards which in turn may produce stretching and tearing of cerebellar veins. [ 13 ] In our case the intraoperative CSF loss was not recorded as the ventricles were not breached and it was miniscule.…”

Section: Discussionmentioning

confidence: 99%

Remote cerebellar haemorrhage: A case report

Kumar

Kale

2020

Indian Journal of Radiology and Imaging

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Intracranial haemorrhage after supra-tentorial craniotomies can occur in a typical pattern and location which may suggest the diagnosis of remote cerebellar haemorrhage (RCH) which is quite a rare occurrence. The ‘Zebra Sign’ refers to a pattern of hyperdensity indicative of blood and hypodensity indicative of normal cerebellar parenchyma in a curvilinear, stripe-like fashion along the cerebellar folia and is a characteristic imaging finding in RCH. RCH in general doesn't require surgical treatment, however in cases of significant hydrocephalus or progressive deterioration of consciousness surgical treatment may be warranted. The knowledge of this condition is important as it can pre-empt unnecessary further investigations and biopsy. Although imaging appearance may be striking, close imaging follow-up and clinical monitoring are often enough for the management of this entity.

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Section: Discussionmentioning

confidence: 99%

Remote cerebellar haemorrhage: A case report

Kumar

Kale

2020

Indian Journal of Radiology and Imaging

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“…[ 1 – 8 ] Although the exact pathophygiology of RCH has not been established, it is largely accepted that it has a venous origin and is likely the result of massive CSF loss during the intraoperative and/or postoperative period. [ 1 – 4 , 6 , 7 ] With significant CSF loss, the cerebellum may sag and stretch cerebellar bridging veins into the tentorium, torcular, and transverse sinus. These stretched veins result in transient occlusion and consequent increased venous pressure.…”

Section: Discussionmentioning

confidence: 99%

Fatal remote cerebellar hemorrhage after supratentorial unruptured aneurysm surgery in patient with previous cerebellar infarction

Koh

Park

2017

Medicine

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Rationale:Remote cerebellar hemorrhage (RCH) is a rare complication of supratentorial and spinal surgeries, seldom requiring intervention but occasionally causing significant morbidity or even mortality. Although a number of theories have been proposed, the exact pathophysiology of RCH remains incompletely understood.Patient concerns:We present a 62-year-old patient with RCH encountered following surgical clipping of an unruptured middle cerebral artery bifurcation aneurysm in a patient with previous cerebellar infarction.Lessons:It is extremely rare, but sometimes, RCH can be life-threatening. It is necessary to check the patient's general condition, underlying diseases and medical history. And controlled drainage of the CSF seems to be most important. Arachnoidplasty may be a consideration and the position of the drain string might have to be carefully determined.

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“…RCH after a supratentorial craniotomy can be treated conservatively or decompressed using a ventricular drain or craniectomy with good clinical outcomes. 4,10,12,16,19 With excessive loss of CSF and RCH observed on CT imaging, drains should be discontinued to prevent exacerbation of the RCH. 4 Other authors have recommended against the use of suction drainage 11,21 and intraoperative mannitol for procedures at higher risk of RCH (hemorrhage severity and patient age).…”

Section: Discussionmentioning

confidence: 99%

Upward transtentorial herniation following frontoorbital advancement for syndromic craniosynostosis: case report

Mehta

Bakhsheshian

Dorafshar

et al. 2015

FOC

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The authors describe the case of a boy with Muenke syndrome, an autosomal dominant disorder associated with craniosynostosis. The family history was significant for syndromic craniosynostosis in the patient’s maternal grandmother, who died in adulthood after a craniofacial reconstruction. The patient, her grandson, underwent craniofacial reconstruction surgery at the age of 9 months and developed upward transtentorial herniation. Imaging findings revealed remote cerebellar hemorrhage after a large quantity of supratentorial CSF was drained during postoperative Day 1. The clinical course was further complicated by cerebral sinus thrombosis, which was diagnosed after a fourth surgical procedure. Upward transtentorial herniation can occur when a significant increase in intracranial pressure in the posterior fossa causes displacement of the central lobule and superior surfaces of the cerebellum upward through the incisura tentorii. This is a rare but well-documented phenomenon that commonly occurs in the setting of an expansive posterior fossa lesion or excessive supratentorial CSF loss. To help clinicians recognize and prevent this rare but potentially fatal complication, the authors review the postulated mechanisms by which this process may occur.

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

Cited by 5 publications

References 14 publications

Remote cerebellar haemorrhage: A case report

Remote cerebellar haemorrhage: A case report

Fatal remote cerebellar hemorrhage after supratentorial unruptured aneurysm surgery in patient with previous cerebellar infarction

Upward transtentorial herniation following frontoorbital advancement for syndromic craniosynostosis: case report

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