Remote Cerebellar Hemorrhage after Frontal Lobectomy: Zebra Sign

Can Yaldiz^1*, Volkan Murat Unal², Omer Akar³, Onur Yaman⁴, Nail Ozdemir¹

¹Department of Neurosurgery, Sakarya Training and Research Hospital, Sakarya, Turkey.
²Tepecik Education and Research Hospital, Department of Neurosurger, Izmir, Turkey.
³Kahramanmaras State Hospital, Neurosurgery, Kahramanmaras, Turkey.
⁴TOBB University of Economics and Technology, Department of Mechanical Engineering, Ankara, Turkey.

DOI: 10.4236/ojmn.2014.44031                

Abstract

Remote cerebellar hemorrhages (RCHs) are rare complications of intracranial or spinal interventions. We describe a patient with an RCH that occurred after a frontal lobectomy for an intracranial tumor. A 41-year-old female patient with a headache and partial seizures underwent a right frontal lobectomy upon detection of a right frontal mass. An RCH (zebra sign) was detected on a control cranial computed tomography (CT), which was performed upon detection of frontal lobe syndrome and mild ataxia in the patient postoperatively. Although the mechanism underlying the occurrence of RCHs after intracranial procedures is not clear, they have been attributed to an imbalance between intravascular pressure and cerebrospinal fluid (CSF) due to rapid drainage of the fluid, causing bleeding in the cerebellar parenchyma. Generally, bilateral superior cerebellar injury produces parallel flat hyperdense areas known as the zebra sign on CT. The prognosis of a cerebellar hemorrhage is generally good, and it can be treated with a conservative approach. Controlled drainage of CSF during surgery and selecting an appropriate surgical position perioperatively will reduce the risk of RCHs.

Keywords

Zebra Sign, Remote Cerebellar Hemorrhage, Lobectomy

Conflicts of Interest

The authors declare no conflicts of interest.

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