Remote cerebellar haemorrhages are a relatively benign, but extremely rare, complication of supratentorial craniotomy or spinal surgery 1,2. It is called 'remote' as the cerebellar haemorrhage is far from the location of the surgery.
Most patients are asymptomatic 2. When symptomatic, delayed awakening from anaesthesia and reduced level of consciousness are the frequently reported symptoms. It often tends to have a self-limiting course.
It has been postulated that post-surgical CSF hypovolaemia causes cerebellar sagging and occlusion of superior penetrating veins and hence haemorrhagic infarction. The exact pathophysiology, however, is not clear.
The most common radiologic finding is layering of blood over superior folia, called the zebra sign 6,7 and less frequently it can be an intraparenchymal or lobar haemorrhage. Cerebellar haemorrhage can be contralateral or ipsilateral to the site of surgery and sometimes on both sides or even can be isolated to the vermis. The right clinical context is invaluable for image interpretation.
- 1. Amini A, Osborn AG, Mccall TD et-al. Remote cerebellar hemorrhage. AJNR Am J Neuroradiol. 2006;27 (2): 387-90. AJNR Am J Neuroradiol (full text) - Pubmed citation
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- 5. Park JS, Hwang JH, Park J et-al. Remote cerebellar hemorrhage complicated after supratentorial surgery: retrospective study with review of articles. J Korean Neurosurg Soc. 2009;46 (2): 136-43. doi:10.3340/jkns.2009.46.2.136 - Free text at pubmed - Pubmed citation
- 6. Brockmann MA, Nowak G, Reusche E et-al. Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report. J. Neurosurg. 2005;102 (6): 1159-62. doi:10.3171/jns.2005.102.6.1159 - Pubmed citation
- 7. Brockmann MA, Groden C. Remote cerebellar hemorrhage: a review. Cerebellum. 2006;5 (1): 64-8. doi:10.1080/14734220500521032 - Pubmed citation