European Journal of Radiology 70 (2009) 7–9 Remote cerebellar hemorrhage after lumbar spinal surgery Belma Cevik ∗ , Ismail Kirbas, Banu Cakir, Kayihan Akin, Mehmet Teksam Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490, Turkey Received 3 August 2007; accepted 10 January 2008 Abstract Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Cerebellum; Remote cerebellar hemorrhage; Spinal surgery; CT 1. Introduction Intracranial hemorrhage following surgery is well known, but cerebellar hemorrhage is rare as a complication of supratento- rial craniotomy or spinal surgery. The incidence of cerebellar hemorrhage is especially high at 12.9% in patients who under- went temporal lobe resection [1]. Some authors suggest that remote cerebellar hemorrhage (RCH) occurs due to venous infarction, but the pathophysiology and etiology of this condi- tion are unknown [2–6]. This type of bleeding pattern includes blood in the folia of one or both cerebellar hemispheres and ver- mis facing the tentorium, intracerebellar hemorrhage, and in the upper parts of the cerebellum. In this report, we determined the incidence of RCH after lumbar spinal surgery and described diagnostic imaging findings of patients with RCH. ∗ Corresponding author. Tel.: +90 312 212 6868x1163; fax: +90 312 223 7333. E-mail address: belmac@baskent-ank.edu.tr (B. Cevik). 2. Methods Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The original presentation of patients before the surgery were herniated lumbar disc, spinal stenosis, spondilolisthesis, trauma, lumbar spinal tumor and they underwent multiple- level laminectomy, discectomy, stabilization and lumbar spinal tumor excision. Twenty-four of 37 patients had brain CT (16- channel Somatom Sensation, and 4-channel, Somatom Volume Zoom, Siemens Medical Systems, Erlangen, Germany), and 10 patients had brain MRI (1.0-Tesla, Magnetom Expert Impact, and 1.5-Tesla, Symphony, Siemens Medical Systems, Erlangen, Germany). Three of 37 patients had both brain CT and MRI. CT protocol was included 2.5 or 3 mm slice thickness for pos- terior fossa, 8 or 9 mm slice thickness for cerebrum. Contrast media was not administered during the CT scan. MRI proto- col was included transverse and sagittal T1-weighted (TR/TE: 500/13), transverse FLAIR (TI: 2500, TR/TE: 9000/105), and 0720-048X/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2008.01.004