Remote Cerebellar Hemorrhage due to Cerebrospinal Fluid Leakage or Meningitis after Spinal Surgery - Case Report -

Sang Hun Ko; Jae-Ryong Cha; Hang Ki Kang; Sung Do Cho; Kwang Hwan Jung; Chae Chil Lee; Yun Suck Yeom; Sang Woo Kim

doi:10.4184/jkss.2016.23.1.31

Journal List > J Korean Soc Spine Surg > v.23(1) > 1076116

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Ko, Cha, Kang, Cho, Jung, Lee, Yeom, and Kim: Remote Cerebellar Hemorrhage due to Cerebrospinal Fluid Leakage or Meningitis after Spinal Surgery - Case Report -

Case Report

Journal of Korean Spine Surg 2016;23(1):31-35.

Published online: 31 March 2016

DOI: https://doi.org/10.4184/jkss.2016.23.1.31

Remote Cerebellar Hemorrhage due to Cerebrospinal Fluid Leakage or Meningitis after Spinal Surgery - Case Report -

Sang Hun Ko, M.D., Jae-Ryong Cha, M.D., Hang Ki Kang, M.D., Sung Do Cho, M.D., Kwang Hwan Jung, M.D., Chae Chil Lee, M.D., Yun Suck Yeom, M.D., Sang Woo Kim, M.D.

Department of Orthopedic Surgery, Ulsan University Hospital, College of Medicine, Ulsan University

Corresponding author: Jae-Ryong Cha, M.D. Department of Orthopedic Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan 682-714, Korea TEL: +82-52-250-7129, FAX: +82-52-235-2823 E-mail: jrcha@uuh.ulsan.kr

Received 13 March 20159 July 2015 Accepted 8 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

To report a rare case of remote cerebellar hemorrhage (RCH) as a complication of spinal surgery.

Summary of Literature Review

Remote cerebellar hemorrhage is rare but lethal as a complication of spinal surgery. Interestingly, dural tears and cerebrospinal fluid (CSF) leakage are reported in all published cases of RCH.

Materials and Methods

A 67-year-old man had posterior lumbar decompression and posterolateral fusion for spinal stenosis at L4/5/ S1. Intraoperatively, the dura was torn and there was a loss of CSF. The dural tear was sutured immediately in a water-tight manner. After surgery, the patient complained of headache and dizziness. On postoperative day 44, brain magnetic resonance imaging (MRI) showed meningeal enhancement suggesting meningitis. On postoperative day 54, brain computed tomography (CT) showed cerebellar edema and hemorrhage, and external ventricular derivation was performed.

Results

The patient died.

Conclusions

Special attention should be paid to prevent dural damage during spinal surgery or minimize CSF leakage in the case of dural damage and tears during spinal surgery, and CT and MRI should be promptly performed for symptomatic patients.

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Keywords: Complication, Spinal surgery, Remote cerebellar hemorrhage, Cerebrospinal fluid, Dural tear, Meningitis

REFERENCES

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Fig. 1.

Computed tomography (CT) findings for the brain: Moderate ventriculomegaly.

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Fig. 2.

Magnetic resonance imaging (MRI) findings for the brain (axial Gd-enhanced T1): Prominent enhancement of meninges and moderate ventriculomegaly.

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Fig. 3.

MRI findings for the lumbar spine (sagittal Gd-enhanced T1): Fluid collection at the laminectomy site and around the fix-ators.

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Fig. 4.

CT findings for the brain: Acute cerebellar hemorrhage with diffuse parenchymal swelling in both cerebellar hemi-spheres.

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