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Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery.

Watanabe S, Ohtori S, Orita S, Yamauchi K, Eguchi Y, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Inage K, Sainoh T, Sato J, Shiga Y, Abe K, Fujimoto K, Kanamoto H, Inoue G, Furuya T, Koda M, Okawa A, Takahashi K, Yamazaki M - Case Rep Orthop (2015)

Bottom Line: Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak.Leakage of cerebrospinal fluid may have induced this hemorrhage.While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.

ABSTRACT
Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

No MeSH data available.


Related in: MedlinePlus

Hemorrhage was observed in both the left cerebellum (a) and the temporal lobe (b) 5 days after spine surgery on CT.
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fig3: Hemorrhage was observed in both the left cerebellum (a) and the temporal lobe (b) 5 days after spine surgery on CT.

Mentions: Five days postoperatively, clouding of consciousness started gradually. We found headache and gait disturbance however did not find any change of her vital sign. Intracranial hemorrhage was revealed by CT (Figure 3). Hemorrhage was observed in the cerebellum and the temporal lobe. We consulted the neurosurgery service and they performed emergent evacuation of the hematoma. After the procedure, the patient recovered full consciousness but did have some degree of dysphagia. One month after surgery, she could walk with the help of a cane and was discharged. Twenty-four months after surgery, the patient could walk unassisted and no longer had dysphagia nor any other neurologic sequelae. However, MRI showed CSF accumulation within her back (Figure 4).


Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery.

Watanabe S, Ohtori S, Orita S, Yamauchi K, Eguchi Y, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Inage K, Sainoh T, Sato J, Shiga Y, Abe K, Fujimoto K, Kanamoto H, Inoue G, Furuya T, Koda M, Okawa A, Takahashi K, Yamazaki M - Case Rep Orthop (2015)

Hemorrhage was observed in both the left cerebellum (a) and the temporal lobe (b) 5 days after spine surgery on CT.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4538974&req=5

fig3: Hemorrhage was observed in both the left cerebellum (a) and the temporal lobe (b) 5 days after spine surgery on CT.
Mentions: Five days postoperatively, clouding of consciousness started gradually. We found headache and gait disturbance however did not find any change of her vital sign. Intracranial hemorrhage was revealed by CT (Figure 3). Hemorrhage was observed in the cerebellum and the temporal lobe. We consulted the neurosurgery service and they performed emergent evacuation of the hematoma. After the procedure, the patient recovered full consciousness but did have some degree of dysphagia. One month after surgery, she could walk with the help of a cane and was discharged. Twenty-four months after surgery, the patient could walk unassisted and no longer had dysphagia nor any other neurologic sequelae. However, MRI showed CSF accumulation within her back (Figure 4).

Bottom Line: Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak.Leakage of cerebrospinal fluid may have induced this hemorrhage.While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.

ABSTRACT
Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

No MeSH data available.


Related in: MedlinePlus