Case Report Remote Cerebellar Haemorrhage: A Potential Iatrogenic Complication of Spinal Surgery Muhammad Atif Naveed , 1 Rajiv Mangla , 2 Hajra Idrees, 1 and Rashi I. Mehta 3 1 Department of Radiology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan 2 Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA 3 Department of Radiology, West Virginia University, Morgantown, WV, USA Correspondence should be addressed to Rashi I. Mehta; rashi.mehta@hsc.wvu.edu Received 3 June 2018; Revised 26 July 2018; Accepted 27 August 2018; Published 16 September 2018 Academic Editor: Mehmet Turgut Copyright © 2018 Muhammad Atif Naveed et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report the case of a 51-year-old man with no signifcant past medical history, who underwent elective revision spinal surgery and subsequently developed intracranial hypotension, remote cerebellar haemorrhage (RCH), and mild hydrocephalus on the fourth postoperative day. Remote cerebellar haemorrhage is a known complication of supratentorial surgery. Tis iatrogenic phenomenon may also occur following spinal surgery, due to dural tearing and rapid cerebral spinal fuid (CSF) leakage, resulting in intracranial hypotension and cerebellar haemorrhage. Tis complication may result in severe permanent neurologic sequelae; hence, it is of pertinence to diagnose and manage it rapidly in order to optimise patient outcome. 1. Case Report A 51-year-old male, with a remote previous history of L4-L5 spinal decompression and fusion, presented in our outpatient clinic with worsening lower back pain. Physical examination showed lumbar radiculopathy and neurogenic claudication, while a magnetic resonance imaging (MRI) scan of the lumbar spine revealed disc protrusions and high-grade spinal canal stenosis at the L2-L3 and L3-L4 levels. Consequently, he underwent elective spinal decompression revision surgery, with an extension of instrumented fusion from L2-L5. On experiencing new onset persistent headaches on the second postoperative day, a computerized tomography (CT) myelogram was performed, and showed CSF leakage from a dural tear at the L3-L4 level (Figure 1). Soon afer the CT myelogram, image-guided lumbar drain placement was performed, and 8cc of fbrin glue was injected at the site of the leak. On the fourth postoperative day, an urgent unenhanced CT scan of the head was performed afer the patient developed altered mental status, confusion, disorientation, and slurred speech. Te CT scan revealed areas of acute haemorrhage in both cerebellar hemispheres, with mass efect on the fourth ventricle and the brainstem and mild obstructive hydrocephalus (Figure 2). Subsequent review of nursing charts revealed excess CSF drainage over the previous night; thus, immediate clamping of the lumbar drain was performed, and an external ventricular drain (EVD) was placed by the neurosurgery team. MRI scanning of the brain, with and without contrast, revealed evidence of intracranial hypotension (Figure 3). On the fourteenth postoperative day, the patient had an open surgical dural repair using direct suture closure, along with DuraGen5 (a synthetic dural allograf), and fbrin glue. Additionally, the lumbar drain was successfully removed. Te patient’s subsequent hospital course was complicated by deep venous thrombosis and respiratory failure, and he was ultimately discharged to the rehabilitation unit afer EVD removal, ten days afer the open dural repair surgery. No residual neurological defcits were present at the time of discharge. 2. Discussion Remote cerebellar haemorrhage (RCH) refers to a postoper- ative parenchymal cerebellar haemorrhage, remote from the Hindawi Case Reports in Neurological Medicine Volume 2018, Article ID 5870584, 4 pages https://doi.org/10.1155/2018/5870584