Bokhari Rakan, Baeesa Saleh
Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Saudi Arabia.
J Med Case Rep. 2012 Jul 30;6:222. doi: 10.1186/1752-1947-6-222.
Cerebellar hemorrhage remote from the operative site is an unpredictable and rare complication in neurosurgery, with reported rates of morbidity and mortality in the literature of 8.4% and 7.8%, respectively. The range of procedures associated with remote cerebellar hemorrhage is diverse and includes both supratentorial and spinal procedures that entail significant cerebral spinal fluid loss or resection of supratentorial content. We present here the first documented case of remote cerebellar hemorrhage after controlled supratentorial cerebral spinal fluid drainage by ventriculoperitoneal shunt, and discuss the proposed pathophysiology and treatment.
We present the case of a four-month-old Saudi Arabian male baby who presented with progressive symptoms and signs of congenital hydrocephalus. An uneventful ventriculoperitoneal shunting was performed with our patient recovering smoothly in the immediate postoperative period. On the next day, he had frequent episodes of vomiting and became lethargic. An urgent computed tomography scan of his brain revealed mild ventricular decompression and unexpected cerebellar hemorrhage. The infant was put under close observation, with marked spontaneous improvement over 48 hours and complete resolution of the hemorrhage on a follow-up computed tomography brain scan two weeks later. On regular outpatient visits at one, three and twelve months, he had no neurological deficit.
Remote cerebellar hemorrhage is a complication that remains enigmatic in terms of both the underlying mechanism and clinical behavior. Our case revealed that the risk factors identified in the literature are not sufficient in predicting patients at risk of developing remote cerebellar hemorrhage. Our report also adds to the growing body of evidence challenging the currently accepted hypothesis explaining the pathomechanism of remote cerebellar hemorrhage. It thereby remains an unpredictable hazard that requires further study and increased awareness, as many cases in the literature are incidental findings.
手术部位以外的小脑出血是神经外科中一种不可预测的罕见并发症，文献报道的发病率和死亡率分别为8.4%和7.8%。与手术部位以外的小脑出血相关的手术范围多种多样，包括幕上和脊柱手术，这些手术会导致大量脑脊液流失或幕上内容物切除。我们在此报告首例经脑室腹腔分流术控制幕上脑脊液引流后发生手术部位以外小脑出血的病例，并讨论其可能的病理生理学及治疗方法。
我们报告一例四个月大的沙特阿拉伯男婴，其出现先天性脑积水的进行性症状和体征。对该患者顺利实施了脑室腹腔分流术，术后即刻恢复平稳。次日，他频繁呕吐并变得嗜睡。脑部紧急计算机断层扫描显示脑室轻度减压以及意外的小脑出血。该婴儿接受密切观察，48小时内症状显著自发改善，两周后的脑部计算机断层扫描随访显示出血完全消退。在术后1个月、3个月和12个月的定期门诊随访中，他没有神经功能缺损。
手术部位以外的小脑出血在潜在机制和临床行为方面仍是一个谜。我们的病例显示，文献中确定的危险因素不足以预测有发生手术部位以外小脑出血风险的患者。我们的报告还增加了越来越多的证据，对目前被接受的解释手术部位以外小脑出血发病机制的假说提出了挑战。因此，它仍然是一种不可预测的危险，需要进一步研究并提高认识，因为文献中的许多病例都是偶然发现的。
