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Remote Cerebellar Hemorrhage as a Tell-Tale Sign of Unsuspected Spinal CSF Leak 2008

General Spine

Bradley P Thomas, MD,
Thomas S Dina, MD, ASSR Member

Excerpta Extraordinaire

Excerpta

Remote cerebellar hemorrhage (RCH) is a rare occurrence associated with cranial, and less commonly, spinal surgery when there is significant CSF loss. This intraparenchymal hemorrhage pattern is very characteristic and hypothesized to be the result of cerebellar venous compression (Figure 1).

We present a case of a 34 year-old male post-resection of a chondrosarcoma located at the left T3-4 costovertebral junction without intraoperative evidence of dural violation. On post-operative day 2, new neurologic symptoms led to a head CT and subsequent MRI exams that revealed RCH along with diffuse dural enhancement with sagging of the pons and brainstem indicative of CNS hypotension. Following the removal of a peri-operative chest tube, repeat thoracic imaging was suggestive of a complex pseudomeningocele at the operative site (Figures 2 and 3). Surgical exploration revealed what appeared to be loculated CSF collections and presumed spontaneous resolution of a CSF leak.

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