Share This Article:

Remote Cerebellar Hemorrhage after Frontal Lobectomy: Zebra Sign

Abstract Full-Text HTML XML Download Download as PDF (Size:2761KB) PP. 181-185
DOI: 10.4236/ojmn.2014.44031    2,418 Downloads   2,948 Views   Citations

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.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Yaldiz, C. , Unal, V. , Akar, O. , Yaman, O. and Ozdemir, N. (2014) Remote Cerebellar Hemorrhage after Frontal Lobectomy: Zebra Sign. Open Journal of Modern Neurosurgery, 4, 181-185. doi: 10.4236/ojmn.2014.44031.

References

[1] Cemil, B., Kirar, F., Gokce, E.C., Teksam, M. and Erdogan, B. (2010) Supratentoryal ve Spinal Cerrahi Sonras? Gelisen Serebellar Kanamalar: Iki Olgu Sunumu. Türk Norosirürji Dergisi, 20, 117-121.
[2] Amini, A., Osborn, A.G., McCall, T.D. and Couldwell, W.T. (2006) Remote Cerebellar Hemorrhage. AJNR American Journal of Neuroradiology, 27, 387-390.
[3] Bernal-García, L.M., Cabezudo-Artero, J.M., Ortega-Martínez, M., Fernández-Portales, I., Ugarriza-Echebarrieta, L.F., Pineda-Palomo, M., Porras-Estrada, L.F. and Gómez-Perals, L.F. (2008) Remote Cerebellar Hemorrhage after Lumbar Spinal Fluid Drainage. Report of Two Cases and Literature Review. Neurocirugia (Astur), 19, 440-445.
[4] Brockmann, M.A., Nowak, G., Reusche, E., Russlies, M. and Petersen, D. (2005) Zebra Sign: Cerebellar Bleeding Pattern Characteristic of Cerebrospinal Fluid Loss. Case Report. Journal of Neurosurgery, 102, 1159-1162.
http://dx.doi.org/10.3171/jns.2005.102.6.1159
[5] Chadduck, W.M. (1981) Cerebellar Hemorrhage Complicating Cervical Laminectomy. Neurosurgery, 9, 185-189.
http://dx.doi.org/10.1227/00006123-198108000-00016
[6] Marquardt, G., Setzer, M., Schick, U. and Seifert, V. (2002) Cerebellar Hemorrhage after Supratentorial Craniotomy. Surgical Neurology, 57, 241-251.
http://dx.doi.org/10.1016/S0090-3019(02)00642-0
[7] Figueiredo, E.G., Amorim, L.O. and Teixeiria, M.J. (2009) Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights. Neurologia Medico-Chirurgica (Tokyo), 49, 229-234.
http://dx.doi.org/10.2176/nmc.49.229
[8] Cevik, B., Kirbas, I., Cakir, B., Akin, K. and Teksam, M. (2009) Remote Cerebellar Hemorrhage after Lumbar Spinal Surgery. European Journal of Radiology, 70, 7-9.
http://dx.doi.org/10.1016/j.ejrad.2008.01.004
[9] Brisman, M.H., Bederson, J.B., Sen, C.N., Germano, I.M., Moore, F. and Post, K.D. (1996) Intracerebral Hemorrhage Occurring Remote from the Craniotomy Site. Neurosurgery, 39, 1114-1122.
http://dx.doi.org/10.1097/00006123-199612000-00009
[10] Kalfas, I.H. and Little, J.R. (1988) Postoperative Hemorrhage: A Survey of 4992 Intracranial Procedures. Neurosurgery, 23, 343-347.
http://dx.doi.org/10.1097/00006123-199612000-00009
[11] Konig, A., Laas, R. and Herrmann, H.D. (1987) Cerebellar Haemorrhage as a Complication after Supratentorial Craniotomy. Acta Neurochirurgica, 88, 104-108.
http://dx.doi.org/10.1007/BF01404145
[12] Papanastassiou, V., Kerr, R. and Adams, C. (1996) Contralateral Cerebellar Hemorrhagic Infarction after Pterional Craniotomy: Report of Five Cases and Review of the Literature. Neurosurgery, 39, 841-852.
http://dx.doi.org/10.1097/00006123-199610000-00040
[13] Toczek, M.T., Morrell, M.J., Silverberg, G.A. and Lowe, G.M. (1996) Cerebellar Hemorrhage Complicating Temporal Lobectomy: Report of Four Cases. Journal of Neurosurgery, 85, 718-722.
http://dx.doi.org/10.3171/jns.1996.85.4.0718
[14] Yacubian, E.M., de Andrade, M.M., Jorge, C.L. and Valero, R.M. (1999) Cerebellar Hemorrhage after Supratentorial Surgery for Treatment of Epilepsy: Report of Three Case. Neurosurgery, 45, 159-162.
http://dx.doi.org/10.1097/00006123-199907000-00036
[15] Yoshida, S., Yonekawa, Y., Yamashita, K., Ihara, I. and Morooka, Y. (1990) Cerebellar Hemorrhage after Supratentorial Craniotomy: Report of Three Cases. Neurologia Medico-Chirurgica, 30, 738-743.
http://dx.doi.org/10.2176/nmc.30.738
[16] Sasani, M., Sasani, H. and Ozer, A.F. (2010) Bilateral Late Remote Cerebellar Hemorrhage as a Complication of a Lumboperitoneal Shunt Applied after Spinal Arteriovenous Malformation Surgery. Journal of Spinal Cord Medicine, 33, 77-79.
[17] Park, J.S., Hwang, J.H., Park, J., Hamm, I.S. and Park, Y.M. (2009) Remote Cerebellar Hemorrhage Complicated after Supratentorial Surgery: Retrospective Study with Review of Articles. Journal of Korean Neurosurgical Society, 46, 136-143.
http://dx.doi.org/10.3340/jkns.2009.46.2.136

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.