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1
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Boukobza M, Laissy JP. The "zebra sign" after a lumbar puncture. Rev Neurol (Paris) 2024; 180:831-833. [PMID: 38744570 DOI: 10.1016/j.neurol.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 05/16/2024]
Affiliation(s)
- M Boukobza
- Department of Radiology, Bichat-Claude-Bernard University Hospital, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
| | - J-P Laissy
- Department of Radiology, Bichat-Claude-Bernard University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm U1148, Paris University, Paris, France
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2
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Pappa E, Pilichou A, Antonopoulos SI, Maris S, Neroutsos K, Melissaris S, Krallis P. Surgical Treatment of Congenital Kyphosis in Children: Report of a Rare Complication of Remote Cerebellar Haemorrhage. Cureus 2024; 16:e56488. [PMID: 38638780 PMCID: PMC11026067 DOI: 10.7759/cureus.56488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Congenital deformities of the spine lead to an imbalance in the longitudinal growth of the spine. These growth abnormalities may lead to three main patterns of deformity: scoliosis (the most common), kyphosis or lordosis (the least common). Despite the recent improvements in imaging and the routine use of neuromonitoring in the surgical treatment of congenital kyphosis, this surgery may be associated with a high rate of complications such as neurologic deficit, pulmonary thromboembolic events, infection, deep vein thrombosis, implant failure, and dural injury. In this paper, we report a rare yet devastating complication to raise awareness about patients who have unexpected neurological deterioration after spinal surgery. Early recognition of remote cerebellar haemorrhage (RCH) symptoms is crucial since rapid diagnosis and management lead to a favourable outcome for this potentially life-threatening complication. To our knowledge, this is the first reported case in children.
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Affiliation(s)
- Eleni Pappa
- Orthopaedics, KAT General Hospital, Athens, GRC
| | - Anastasia Pilichou
- Orthopaedics and Trauma, Paediatric Orthopaedics, Aghia Sophia Children's Hospital, Athens, GRC
| | | | - Spyridon Maris
- Orthopaedics & Trauma, Hellenic Red Cross General Hospital, Athens, GRC
| | | | - Savvas Melissaris
- Neurosurgery, General Hospital of Athens "G. Gennimatas", Athens, GRC
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Yan X, Yan LR, Ma ZG, Jiang M, Gao Y, Pang Y, Wang WW, Qin ZH, Han YT, You XF, Ruan W, Wang Q. Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery. World J Clin Cases 2023; 11:5430-5439. [PMID: 37637679 PMCID: PMC10450377 DOI: 10.12998/wjcc.v11.i23.5430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication. AIM To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery. METHODS A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded. RESULTS A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019). CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.
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Affiliation(s)
- Xin Yan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Li-Rong Yan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Zhi-Gang Ma
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Ming Jiang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Yang Gao
- Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Ying Pang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Wei-Wei Wang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Zhao-Hui Qin
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Yang-Tong Han
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Xiao-Fan You
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Wei Ruan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Qian Wang
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
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4
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Wang HY, Hu Z, Han J, Wang D, Wu Q. Remote cerebellar hemorrhage following repeated lumbar punctures. BMC Neurol 2023; 23:220. [PMID: 37291540 PMCID: PMC10249246 DOI: 10.1186/s12883-023-03276-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/04/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Remote cerebellar hemorrhage (RCH) is a rare complication in neurosurgery. No case of RCH secondary to repeated lumbar punctures (LPs) has been previously reported. CASE PRESENTATION A 49-year-old man presented with impaired consciousness following persistent fever. Cerebrospinal fluid examination showed high opening pressure, elevated white blood cells, increased protein level, and decreased glucose level, resulting in a diagnosis of bacterial meningoencephalitis. Treatment with repeated LPs and intrathecal injection of ceftriaxone resulted in an improvement in neurological symptoms. However, on day 31 of treatment, brain magnetic resonance image (MRI) showed streaky bleeding in bilateral cerebellum (zebra sign), leading to a diagnosis of RCH. Close observation and repeated brain MRI imaging without specific treatments led to the absorption of bilateral cerebellar hemorrhage, and the patient was discharged with improved neurological symptoms. Repeated brain MRI scans one month after discharge showed that bilateral cerebellar hemorrhage had improved, and had disappeared one year after discharge. CONCLUSION We reported a rare occurrence of LPs-induced RCH presenting as isolated bilateral inferior cerebellar hemorrhage. Clinicians should be vigilant of the risk factors for RCH, closely monitoring patients' clinical symptoms and neuroimaging findings to determine the need for specialized treatment. Furthermore, this case highlights the importance of ensuring the safety of LPs and managing any potential complications appropriately.
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Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, Jining No.1 People's Hospital, Jining, 272000, Shandong Province, China
| | - Zerui Hu
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, 272000, China
| | - Jinming Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Dongsen Wang
- Clinical Medical College of Jining Medical University, Jining, Shandong Province, 272067, China
| | - Qingjian Wu
- Department of Emergency, Jining No.1 People's Hospital, No. 6, Jiankang Road, Jining, 272011, Shandong Province, China.
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5
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Yan X, Pang Y, Yan L, Ma Z, Jiang M, Wang W, Chen J, Han Y, Guo X, Hu H. Perioperative stroke in patients undergoing spinal surgery: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:652. [PMID: 35804343 PMCID: PMC9264537 DOI: 10.1186/s12891-022-05591-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of perioperative stroke following spinal surgery, including ischemic and hemorrhagic stroke, has not been fully investigated in the Chinese population. Whether specific spinal or emergency/elective procedures are associated with perioperative stroke remains controversial. This study aimed to investigate the incidence of perioperative stroke, health economic burden, clinical outcomes, and associated risk factors. METHOD A retrospective cohort study using an electronic hospital information system database was conducted from Jan 1, 2015, to Jan 1, 2021, in a tertiary hospital in China. Patients aged ≥18 years who had undergone spinal surgery were included in the study. We recorded patient demographics, comorbidities, and health economics data. Clinical outcomes included perioperative stroke during hospitalization and associated risk factors. The patients' operative data, anesthetic data, and clinical manifestations were recorded. RESULT A total of 17,408 patients who had undergone spinal surgery were included in this study. Twelve patients had perioperative stroke, including seven ischemic stroke (58.3%) and five hemorrhagic stroke (41.7%). The incidence of perioperative stroke was 0.07% (12/17,408). In total, 12 stroke patients underwent spinal fusion. Patients with perioperative stroke were associated with longer hospital stay (38.33 days vs. 9.78 days, p < 0.001) and higher hospital expenses (RMB 175,642 vs. RMB 81,114, p < 0.001). On discharge, 50% of perioperative patients had severe outcomes. The average onset time of perioperative stroke was 1.3 days after surgery. Stroke history (OR 146.046, 95% CI: 28.102-759.006, p < 0.001) and hyperlipidemia (OR 4.490, 95% CI: 1.182-17.060, p = 0.027) were associated with perioperative stroke. CONCLUSION The incidence of perioperative stroke of spinal surgery in a tertiary hospital in China was 0.07%, with a high proportion of hemorrhagic stroke. Perioperative stroke patients experienced a heavy financial burden and severe outcomes. A previous stroke history and hyperlipidemia were associated with perioperative stroke.
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Affiliation(s)
- Xin Yan
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China.
| | - Ying Pang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Lirong Yan
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Zhigang Ma
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Ming Jiang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Weiwei Wang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Chen
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Yangtong Han
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaolei Guo
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Hongtao Hu
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
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6
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Al-Saadi T, Al-Kindi Y, Allawati M, Al-Saadi H. Intracranial Hemorrhage following Spinal Surgery: A Systematic Review of a Rare Complication. Surg J (N Y) 2022; 8:e98-e107. [PMID: 35252567 PMCID: PMC8894081 DOI: 10.1055/s-0042-1743525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction
Intracranial hemorrhage (ICH) is a potentially severe complication of spinal surgeries. The occurrence of such complications causes deterioration of the patient's clinical status and delayed discharge from the hospital. Although no specific etiological factors were identified for this complication, but multiple risk factors might play role in its development, they include the use of anticoagulants, presence of uncontrolled hypertension, and perioperative patient positioning.
Aim
A systematic review of the literature to investigate the prevalence of different types of intracranial hemorrhages in patients who underwent spinal surgeries.
Methods
A literature review was conducted using multiple research databases. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed.
Results
A total of 79 studies were included in our analysis after applying the exclusion criteria and removing of repeated studies, 109 patients were identified where they were diagnosed with intracranial hemorrhage after spine surgery with a mean age of 54 years. The most common type of hemorrhage was cerebellar hemorrhage (56.0%) followed by SDH and intraparenchymal hemorrhage; 23.9 and 17.4%, respectively. The most common spine surgery was laminectomy (70.6%), followed by fixation and fusion (50.5%), excision of spinal lesions was done in 20.2% of the patient, and discectomy (14.7%).
Conclusion
The data in this study showed that out of 112 patients with ICH, cerebellar hemorrhage was the most common type. ICH post–spine surgery is a rare complication and the real etiologies behind this complication are still unknown, cerebrospinal fluid drain and durotomy were suggested.
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Affiliation(s)
- Tariq Al-Saadi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital- McGill University, Montreal, Canada.,Neurosurgery Department, Khoula Hospital, Muscat, Sultanate of Oman
| | - Yahya Al-Kindi
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Moosa Allawati
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Hatem Al-Saadi
- Department of General Surgery, Sohar Hospital, Sohar, Sultanate of Oman
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Sánchez Zamora P, Gómez Del Pulgar Vázquez B, Gholamian Ovejero S. Intraventricular hemorrhage as complication after spinal surgery. Case report. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:183-186. [PMID: 35272951 DOI: 10.1016/j.redare.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/21/2020] [Indexed: 06/14/2023]
Abstract
Remote intracranial hemorrhage (ICH) is a rare but dreaded complication after spinal surgery. The physiopathology of this phenomenon is closely related to a loss of cerebrospinal fluid (CSF) after an incidental durotomy during spine surgery. The most common remote ICH location is cerebellar, but few articles report intraventricular hemorrhage. Its clinic is associated with cerebral hypotension due to decreased CSF, mainly headache, dysarthria, hemiparesis, an impaired level of awareness and seizures. The diagnosis of remote ICH after a non-cranial surgery can be a challenge to anesthesiologists, this pathology should be suspected face an immediate neurological deterioration after anesthetic awakening. Non-specific symptoms make it difficult to identify the origin of intracranial hemorrhagic from other differential diagnoses. We present a patient with an impaired level of awareness and seizures who suffered a hemorrhage in the right ventricle with cerebral and cerebellar edema in the immediate postoperative period after spinal surgery.
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Affiliation(s)
- P Sánchez Zamora
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
| | - B Gómez Del Pulgar Vázquez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - S Gholamian Ovejero
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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8
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Zhang J, Xue Y, Gao J, Li Y, Shi K, Diao W, Li J. Subarachnoid hemorrhage after full endoscopic transforaminal lumbar interbody fusion: a case report. Br J Neurosurg 2021; 37:1-6. [PMID: 33739220 DOI: 10.1080/02688697.2021.1902473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Intracranial hemorrhage such as subarachnoid hemorrhage (SAH) is a rare but severe complication of spinal surgery. Current case reports of open lumbar surgery are typically accompanied by intraoperative dural tears and cerebrospinal fluid (CSF) leakage. We report a case of non-aneurysmal SAH without CSF leakage after full endoscopic transforaminal lumbar interbody fusion (FE-TLIF). DESIGN Case report and literature review. RESULTS A 62-year-old male patient underwent FE-TLIF for L4/5 lumbar spinal stenosis. There was no intraoperative dural tear or postoperative CSF leakage. The patient reported neck pain immediately after the surgery. Around 12 h after the surgery, the patient complained of mild headaches. One day after the surgery, the patient reported severe headaches, accompanied by nausea and vomiting. CT showed a high-density shadow in part of the sulcus and cistern, suggesting SAH. No apparent neurological symptoms were present. The patient's condition improved after conservative treatment including bed rest, fluid infusions, and blood pressure control. Twelve days after the surgery, CT and MRA of the brain showed no hemorrhage and the patient was discharged. CONCLUSION This case was among the first that developed SAH without CSF leakage after FE-TLIF. Although the underlying pathologic mechanism is unknown, epidural hypertension may be a possible cause of the hemorrhage. Timely CT or magnetic resonance imaging (MRI) examinations may help to detect this complication and initiate early treatment.
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Affiliation(s)
- Jianwei Zhang
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, Xuzhou, China
| | - Youdi Xue
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, Xuzhou, China
| | - Jian Gao
- Department of Orthopaedics, Zhoukou Xiehe Orthopedic Hospital, Zhoukou, China
| | - Yiming Li
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, Xuzhou, China
| | - Kun Shi
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, Xuzhou, China
| | - Wenbo Diao
- Department of Orthopaedics, Zhoukou Xiehe Orthopedic Hospital, Zhoukou, China
| | - Jie Li
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, Xuzhou, China
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9
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Di L, Wei G, Eichberg DG, Komotar RJ, Ivan M. Remote Cerebellar Hemorrhage Associated With Intra-Operative Cerebrospinal Fluid Leak: A Report of Two Rare Case Presentations and Review of the Literature. Cureus 2020; 12:e12082. [PMID: 33489500 PMCID: PMC7805504 DOI: 10.7759/cureus.12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Remote cerebellar hemorrhage (RCH) is a rare complication following cranial or spinal neurosurgical procedures. Traditionally, RCH has been associated with frontal or frontotemporal craniotomy with supine patient positioning. Though the exact etiology is unknown, theories have described patient positioning and excessive cerebrospinal fluid (CSF) drainage intra-operatively as contributing factors to cerebellar displacement (cerebellar sag), obstruction of venous flow, and pathogenesis of RCH. We report two cases of RCH following a prone, suboccipital craniotomy-C1 laminectomy and a temporal burr hole evacuation of a subdural hygroma. In each case, a large volume of CSF was rapidly evacuated intra-operatively. To the best of our knowledge, both instances represent relatively rare settings for RCH. Additionally, we conducted a comprehensive literature review of PubMed, EMBASE, and Web of Science for all cases of RCH in which peri-operative CSF leakage was explicitly detailed. Although RCH is thought to be a rare complication of frontotemporal and frontal craniotomies, this case report signifies that RCH may occur in the setting of sub-occipital craniotomy or even after minimally invasive burr hole procedures. For these procedures, careful symptomatic monitoring and follow-up imaging remain essential in diagnosis. Controlled CSF drainage may be useful in mediating dramatic alterations in intracranial pressure (ICP) and cerebellar sag contributing to RCH.
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Affiliation(s)
- Long Di
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Grace Wei
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Daniel G Eichberg
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Ricardo J Komotar
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.,Neurological Surgery, Sylvester Comprehensive Cancer Center, Miami, USA
| | - Michael Ivan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.,Neurological Surgery, Sylvester Comprehensive Cancer Center, Miami, USA
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10
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Dantas F, Vieira Caires AC, Cariri GA, Rolemberg Dantas FL. Perioperative Ischemic and Hemorrhagic Stroke in Spine Surgery: A Series of 5 Cases. World Neurosurg 2020; 146:e175-e183. [PMID: 33091642 DOI: 10.1016/j.wneu.2020.10.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke is a potentially life-threatening condition that can lead to disability and prolonged hospital stay. Perioperative stroke is a rare complication of spine surgery, especially in elective procedures. The prevalence of this complication varies in the literature, and the physiopathology is uncertain in many cases. Our objective was to describe 5 cases of patients who underwent spine surgery complicated by perioperative stroke and to analyze their characteristics and clinical outcomes. METHODS We retrospectively analyzed data from spine surgeries performed at a single institution from January 2016 to December 2019. Patients who presented with perioperative stroke were included. Data related to patient demographics, postoperative status, hospital stay, type of surgery, American Society of Anesthesiologists (ASA) score, neurologic status at discharge, and mortality were registered. RESULTS Five of 1002 consecutive patients (0.49%) had complication of stroke during surgery. The surgeries included occipitocervical fusion, anterior cervical fusion, lumbar fusion, lumbosacral fusion, and thoracolumbar fusion. The mean age of patients was 52.2 ± 15.73 years (range, 39-78 years), and the mean time of hospitalization was 20 ± 26.93 days (range, 6-68 days). The majority of patients were women (80%). Three patients (60%) presented with ischemic stroke, and 2 patients (40%) had hemorrhagic stroke. Two patients were severely disabled, and 3 showed good neurologic outcomes; no in-hospital deaths were observed. The etiology of stroke remained uncertain in the majority of cases. CONCLUSIONS Despite the rarity of this complication, perioperative stroke in spine surgery can lead to considerable morbidity. Precocious diagnosis and treatment may improve patient outcomes.
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Affiliation(s)
- François Dantas
- Department of Neurosurgery-Biocor Instituto, Nova Lima, Minas Gerais, Brazil; Faculdade de Ciências Médicas de Minas Gerais-Feluma Post-Graduation, Belo Horizonte, Minas Gerais, Brazil
| | | | - Gustavo Agra Cariri
- Department of Neurosurgery-Biocor Instituto, Nova Lima, Minas Gerais, Brazil
| | - Fernando Luiz Rolemberg Dantas
- Department of Neurosurgery-Biocor Instituto, Nova Lima, Minas Gerais, Brazil; Pontifícia Universidade Católica de Minas Gerais-Belo Horizonte, Minas Gerais, Brazil.
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11
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Kinthala S, Jiao K, Ankam A, Paramore CG. Cerebellar Hemorrhage and Spinal Fluid Overdrainage With Tonsillar Herniation Following Spine Surgery. Cureus 2020; 12:e10418. [PMID: 33062533 PMCID: PMC7553715 DOI: 10.7759/cureus.10418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spinal fluid overdrainage with cerebellar hemorrhage is a rare complication of spinal surgery that can have severe consequences if not detected quickly. We present the case of a 72-year-old Caucasian female who underwent thoracolumbar fixation for flatback syndrome. Intraoperatively, the patient suffered a dural injury that was repaired. In the immediate postoperative period, the patient’s neurological status rapidly deteriorated within an hour and Jackson-Pratt (JP) drain output measured 300 ml of serosanguinous fluid. A stat CT scan revealed cerebellar hemorrhage, pneumocephalus, and tonsillar herniation. The postoperative drain was immediately removed, and a ventriculostomy tube was placed, confirming low intracranial pressure. Postoperatively, the patient was electively ventilated for three days, continued with remote cerebellar hemorrhage (RCH) treatment and precaution, and extubated on the third day as the patient’s neurological function continued to improve. The patient was discharged home nine days after the initial surgery, with a complete recovery. This case indicates that wound drainage in the face of durotomy can induce cerebellar herniation as early as within an hour postoperatively following spine surgery with a dural tear, even after dural repair. This case also suggests that early recognition and appropriate management of RCH is the key to a full recovery. Even in the event of tonsillar herniation and cerebellar hemorrhage, a complete recovery is possible with early recognition and proper management.
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Affiliation(s)
| | - Kuiran Jiao
- Anesthesiology, Guthrie Robert Packer Hospital, Sayre, USA
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12
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Renard D, Castelnovo G, Ion I, Guillamo JS, Thouvenot E. Single and simultaneous multiple intracerebral hemorrhages: a radiological review. Acta Neurol Belg 2020; 120:819-829. [PMID: 32449137 DOI: 10.1007/s13760-020-01385-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Abstract
Simultaneous multiple intracerebral hemorrhage (SMICH) is defined as ICH in two or more discrete noncontiguous acute intraparenchymal locations on initial CT. About 5% of ICH patients present with SMICH. ICH/SMICH etiology is classically divided into disorders of primary or secondary origin. About half of primary SMICH cases are caused by cerebral amyloid angiopathy or hypertensive arteriopathy. In this review, we will discuss the radiological features associated with the different causes of primary and secondary ICH and SMICH. Due to its rarity and the associated high morbidity and mortality, we will focus in particular on SMICH.
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Affiliation(s)
- Dimitri Renard
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France.
| | - Giovanni Castelnovo
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Ioana Ion
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Jean Sebastien Guillamo
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
- Institut de Génomique Fonctionnelle, UMR 5203, INSERM 1191, Université Montpellier, Montpellier, France
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13
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Lee I, Park CW, You CJ, Choi DH, Park K, Kim YB, Kim WK, Yee GT, Kim MJ, Kim EY. Risk factors of postoperative remote intracerebral hemorrhage after craniotomy for ruptured cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2020; 22:53-64. [PMID: 32665912 PMCID: PMC7329564 DOI: 10.7461/jcen.2020.22.2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022] Open
Abstract
Objective We aimed to identify the relation between perioperative cerebrospinal fluid (CSF) drain through lumbar drainage (LD) and development of postoperative (POP) remote intracerebral hemorrhage (rICH) in craniotomy to treat ruptured intracranial aneurysms. Methods We retrospectively reviewed consecutive patients who underwent craniotomy for ruptured cerebral aneurysms at the authors’ institution between 1998 and 2004. We subsequently compared the incidence and characteristics of POP rICH between the patients who had a perioperative LD and those who did not. All statistical analyses were conducted using the software package SPSS 19.0 (SPSS Inc., Chicago, IL, USA). A p value of <0.05 was considered statistically significant. Results We enrolled 688 patients, of which 80 patients (11.6%) received perioperative LD, and 608 did not. LD and non-LD groups were comparable because although clinical characteristics of the two groups were significantly different considering history of hypertension, timing of surgery, and closed system negative pressure suction drain (SD) placement, none of these three variables was an independent risk factor associated with POP rICH in multivariate analysis. POP rICH incidence was significantly higher in the LD goup (12.5%) than non-LD group (0.8%) (p=0.000) in univariate analysis. LD placement was the only independent risk factor associated with the development of rICH in multivariate logistic regression analysis. Conclusions POP rICH incidence was significantly higher in patients who were managed with perioperative LD than in those who did not. LD insertion in craniotomy for ruptured intracranial aneurysm, should be closely monitored to address the occurrence of POP rICH.
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Affiliation(s)
- Insu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Chan Jong You
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kwangwoo Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Young Bo Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Gi-Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Myeong-Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Eun Young Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
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14
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Lim CHS, Salkade PR, Peter AC. Remote cerebellar hemorrhage as a complication of lumbar spine surgery. J Radiol Case Rep 2020; 14:1-11. [PMID: 32184932 DOI: 10.3941/jrcr.v14i2.3844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Remote cerebellar hemorrhage (RCH) is a rare yet potentially fatal complication of supratentorial and spinal surgery, where there has been either intentional or accidental breach of the dura. We present a case of RCH following a L4-5 decompression laminectomy complicated by an intraoperative dural tear which was detected and repaired at the time of surgery. Despite prompt intra-operative repair of the dura, there was persistent cerebrospinal fluid leak as evidenced by a high subfascial epidural drain output which resulted in bilateral intraparenchymal cerebellar hemorrhage. The patient was managed conservatively and recovered without neurological deficits.
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15
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Gadde JA, Weinberg BD, Mullins ME. Neuroimaging of Patients in the Intensive Care Unit: Pearls and Pitfalls. Radiol Clin North Am 2019; 58:167-185. [PMID: 31731899 DOI: 10.1016/j.rcl.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A brief introduction is provided of the different imaging modalities encountered in the intensive care unit (ICU). The spectrum of intracranial pathology as well as potential postsurgical complications is reviewed, with a focus on pearls and pitfalls. A brief overview also is provided of imaging of the spine in an ICU patient.
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Affiliation(s)
- Judith A Gadde
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA.
| | - Brent D Weinberg
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA
| | - Mark E Mullins
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA
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16
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Cerebellar Hemorrhage Following an Uncomplicated Lumbar Spine Surgery: Case Report. J Stroke Cerebrovasc Dis 2019; 28:e104-e105. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/27/2018] [Accepted: 12/01/2018] [Indexed: 11/19/2022] Open
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17
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Worm PV, Dalla-Corte A, Brasil AVB, Perondi G, Sfreddo E, Vial ADM, Gago G, da Costa PRF. Cerebellar hemorrhage as a complication of spine surgery. Surg Neurol Int 2019; 10:85. [PMID: 31528423 PMCID: PMC6744776 DOI: 10.25259/sni-121-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/15/2019] [Indexed: 11/04/2022] Open
Abstract
Background The association between remote cerebellar hematoma (RCH) and spinal surgery is poorly understood and rarely reported. We present seven cases of RCH after spinal surgery. Methods Seven patients were diagnosed with RCH utilizing computed tomography and/or magnetic resonance, between 2012 and 2016. Their clinical presentations, imaging data, treatment modalities, and outcome were analyzed. There were five females and two males with an average age of 55.8 ± 8.4 years. The age of onset ranged from 43 to 67 years and the time to clinical presentation ranged from 3 h to 5 days. Patients presented with: diplopia/strabismus (one patient), dysphagia/urinary incontinence (one patient), respiratory arrest (one patient), meningismus (one patient), and dysarthria (two patients), along with other symptoms/signs. Results Three patients were successfully managed without surgery, two required external ventricular drainage, and two were treated with posterior fossa decompression plus ventriculostomy. Four patients recovered completely, two showed mild residual deficits at discharge, while one expired 7 days postoperatively. Conclusion RCH is an uncommon and underdiagnosed complication of spine surgery. It should be suspected when intracranial symptoms occur after spinal procedures.
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Affiliation(s)
- Paulo Valdeci Worm
- Department of Neurological Surgery, Sao Jose Hospital, Santa Casa Hospital Complex, RS, Brazil.,Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | - Amauri Dalla-Corte
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | | | - Gerson Perondi
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | - Ericson Sfreddo
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
| | | | - Guilherme Gago
- Department of Neurological Surgery, Sao Jose Hospital, Santa Casa Hospital Complex, RS, Brazil
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18
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Doddamani RS, Sawarkar D, Meena RK, Gurjar H, Singh PK, Singh M, Chandra PS, Sathyarthee G. Remote Cerebellar Hemorrhage Following Surgery for Supratentorial Lesions. World Neurosurg 2019; 126:e351-e359. [PMID: 30822579 DOI: 10.1016/j.wneu.2019.02.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Remote cerebellar hemorrhage (RCH) after intracranial surgery is a rare complication. Cerebellar hemorrhage is the most commonly described remote site hemorrhage after surgery for supratentorial pathologies. Although this is a rare complication 0.04% to 0.8%, it can be devastating in terms of patient outcome. There are various hypotheses to explain the occurrence of RCH. We report 6 cases of RCH after surgery for supratentorial lesions, discuss the pathophysiology, and review the pertinent literature. METHODS We retrospectively analyzed data of patients who underwent surgery for supratentorial lesions at our center between 2015 and 2017. We identified 6 patients who developed RCH among 1200 patients who underwent surgery and reviewed the demographic data, diagnosis, surgical procedure, and final outcome. RESULTS A total of 1200 patients underwent surgery for supratentorial pathologies between 2015 and 2017. Six patients developed RCH (incidence, 0.5%); 5 were male and 1 was female, with a mean age of 46.4 years. One patient underwent suboccipital decompression for RCH; the rest 5 were managed with close observation and serial imaging. The Glasgow outcome scale (GOS) of 5 was observed in 4 patients, GOS of 4 in 1 patient at discharge, and GOS of 1 in 1 patient who succumbed to severe pulmonary infection after surgery. CONCLUSIONS RCH is a rare complication but can lead to catastrophic results. Loss of large volumes of cerebrospinal fluid or sudden alteration in intracranial pressure due to removal of a mass lesion is the likely etiology. Although majority of cases may be managed conservatively, in a subset of cases with neurologic deterioration, surgery may be required as a life-saving procedure.
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Affiliation(s)
| | - Dattaraj Sawarkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Meena
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gurudatta Sathyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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19
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La Rocca G, Della Pepa GM, Sturiale CL, Sabatino G, Auricchio AM, Puca A, Olivi A, Marchese E, Albanese A. Lateral Supraorbital Versus Pterional Approach: Analysis of Surgical, Functional, and Patient-Oriented Outcomes. World Neurosurg 2018; 119:e192-e199. [DOI: 10.1016/j.wneu.2018.07.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
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20
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Sim SY, Song J, Oh SY, Kim MJ, Lim YC, Park SK, Shin YS, Chung J. Incidence and Characteristics of Remote Intracerebral Hemorrhage After Endovascular Treatment of Unruptured Intracranial Aneurysms. World Neurosurg 2016; 95:335-340. [PMID: 27565469 DOI: 10.1016/j.wneu.2016.08.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the incidence and characteristics of remote intracerebral hemorrhage (ICH) after endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). METHODS Between March 2007 and September 2015, 11 patients with remote ICH from a series of 2258 consecutive patients with 2597 UIAs treated via EVT were identified. Baseline demographic characteristics, medical history, radiologic imaging data, characteristics of remote ICH, and clinical outcomes were retrospectively reviewed. The characteristics of patients with remote ICH were compared with those of patients without remote ICH. RESULTS All hematomas were single lesions located in the subcortical white matter as lobar-type in 9 patients (81.8%) and in the basal ganglia in 2 patients (18.2%). Events occurred mostly within 1 week and up to 3 weeks after EVT. Hematoma was located on the ipsilateral side in 8 patients (72.7%) and in the contralateral side in 3 patients (27.3%). Compared with patients without remote ICH, there were more aneurysms located on the internal carotid artery (ICA) (P = 0.041), more patients treated with stents (P < 0.001), more patients with hypertension (P = 0.026), and poorer clinical outcomes at discharge (P < 0.001) for patients with remote ICH. CONCLUSIONS The incidence of remote ICH after EVT of UIAs was 0.46%. This event occurred mostly in patients with stents, hypertension, and UIAs on the ICA. It presented mostly as an ipsilateral lobar-type hemorrhage within 1 week after the procedure. This complication should not be neglected because of its poor clinical outcomes.
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Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Jihye Song
- Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Se-Yang Oh
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Myeong Jin Kim
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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