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

Abstract

IntroductionRemote cerebellar hemorrhage is a rare complication of spinal surgery. Although loss of cerebrospinal fluid seems to play an important role in the pathogenesis of this complication, the detailed mechanism of remote cerebellar hemorrhage after spinal surgery remains unclear. We report the case of a patient with remote cerebellar hemorrhage following thoracic spinal surgery of an intradural extramedullary tumor and discuss this entity with reference to the literature.Case presentationA 57-year-old Japanese woman presented to our hospital with back pain, dysuria, and numbness of both legs. A neurological examination was performed, and imaging was performed with ordinary radiography, magnetic resonance imaging, and computed tomography. Her magnetic resonance imaging scan showed an intradural extramedullary tumor at the T3 level. A tumor resection and T1-T5 pedicle screw fixation were performed. Twelve hours after spinal surgery, she complained of unexpected dizziness, nausea, and vomiting. A total of 850mL of serosanguineous fluid had been drained at that time, and drainage was stopped. An urgent brain computed tomography scan showed a cerebellar hemorrhage. She was treated conservatively, and was able to leave hospital six weeks after the initial operation, without any neurological deficits except for slight ataxia.ConclusionsRemote cerebellar hemorrhage has to be suspected when unexpected neurological signs occur after spinal surgery. If an excessive amount of cerebrospinal fluid drains from the drainage tube after spinal surgery, drainage should be stopped.

Remote cerebellar hemorrhage as a complication of lumbar spine surgery

“…Clinical suspicion and early detection are critical. When patients present with neurological signs or symptoms suggestive of raised intracranial pressure following spine or supratentorial surgery, the drains should be checked for increased volumes of drained fluid (and possibly suction stopped) [21], [22]. Prompt evaluation with neuroimaging should be performed [1], [21].…”

Characteristics of Hemorrhagic Stroke following Spine and Joint Surgeries

“…So closed wound suction drainage is recommended for spinal surgery especially tumor resection, and the time to stop drainage is determined by the complaints of patients including headache and emesis [8]. In other words, early diagnosis is also very important for the treatment of intracranial hemorrhage after spinal surgery.…”

Intracranial hemorrhage after spinal surgery: a literature review

“…Patients rarely manifested with visual impairment, neck rigidity, or irritability. These symptoms encountered in the early phase after spinal surgery can indicate a potential intracranial hemorrhage, and timely radiological examination is warranted ( 12 , 13 ). CT is generally the first-line imaging modality for diagnosis.…”

“…Some studies have suggested that intracranial venous or arterial hemorrhage may be caused by low intracranial pressure secondary to excessive intraoperative or postoperative leakage of cerebrospinal fluid ( 12 ). When the intracranial pressure decreases, the cerebella shift may lead to the traction or occlusion of superior cerebellar veins, resulting in subsequent hemorrhagic venous infarction ( 13 ). Pallud et al also pointed out that cerebellar hemorrhage may be secondary to cerebellar occlusion and edema caused by traction and tear of the superior cerebellar veins ( 15 ).…”