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.
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Clinical presentation
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.
Pathology
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.
Radiographic features
CT
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.
Treatment and prognosis
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.
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Stroke and intracranial haemorrhage
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stroke and intracranial hemorrhage
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ischemic stroke
- general discussions
- scoring and classification systems
- signs
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- alexia without agraphia syndrome: PCA
- cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
- Balint syndrome: bilateral PCA
- internal capsule infarct
- ataxic hemiparesis syndrome: MCA perforators or basilar artery perforators
- lacunar infarct
- thalamic infarct
- Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
- top of the basilar syndrome
- striatocapsular infarct
- cerebellar infarct
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brainstem infarct
- midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Nothnagel syndrome: PCA
- Weber syndrome: PCA
- pontine infarct
- Brissaud-Sicard syndrome
- facial colliculus syndrome
- Gasperini syndrome: basilar artery or AICA
- inferior medial pontine syndrome (Foville syndrome): basilar artery
- lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
- locked-in syndrome: basilar artery
- Millard-Gubler syndrome: basilar artery
- Raymond syndrome: basilar artery
- medullary infarct
- Babinski-Nageotte syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- treatment options
- complications
-
intracranial hemorrhage
-
intra-axial hemorrhage
- signs
- by region or type
- extra-axial hemorrhage
-
intra-axial hemorrhage
-
ischemic stroke
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