Remote cerebellar hemorrhage

Remote cerebellar hemorrhages are a relatively benign, but extremely rare, complication of supratentorial craniotomy or spinal surgery 1,2.  It is called 'remote' as the cerebellar hemorrhage is far from the location of the surgery. 

Most patients are asymptomatic 2. When symptomatic, delayed awakening from anesthesia and reduced level of consciousness are the frequently reported symptoms, although cerebellar signs such as ataxia can also be present 1. It often tends to have a self-limiting course 1

It has been postulated that post-surgical CSF hypovolemia causes cerebellar sagging and occlusion of superior penetrating veins and hence hemorrhagic infarction 1. 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 hemorrhage. Cerebellar hemorrhage can be contralateral or ipsilateral to the site of surgery, and less commonly can be bilateral or even can be isolated to the vermis. The right clinical context is invaluable for image interpretation.

Generally, no specific management is required 1. However, if the hemorrhage is large enough to cause obstructive hydrocephalus, then further neurosurgical intervention is required 1.

Stroke and intracranial haemorrhage
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Article information

rID: 10167
Synonyms or Alternate Spellings:
  • Remote cerebellar hemorrhage
  • Remote cerebellar haemorrhage

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Cases and figures

  • Case 1
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  • Case 2: day 1 post supratentorial SDH evacuation
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  • Case 3
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  • Case 4
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