Remote intracranial parenchymal haematomas as complications of spinal surgery: presentation of three cases with minor or untypical symptoms

Abstract

Introduction: Intracranial haemorrhage is a rare complication of spinal surgery. Three cases of cerebral or cerebellar haemorrhages following spinal operations with CSF loss are reported, and the literature was reviewed.

Case presentations: One patient suffered from melancholy after the operation, one patient had moderate headache and nausea, and the third patient suffered from mental confusion and anxiety. The intracranial haemorrhages were treated conservatively. All patients recovered from the bleedings.

Results: The cases show that cerebral or cerebellar haemorrhage after spinal CSF loss may be accompanied by minor or rather untypical clinical symptoms.

Conclusion: The dangerous complication of intracranial haemorrhage has to be kept in mind when patients have moderate cerebral symptoms after CSF loss due to spinal operations.

Fig. 1

Post-operative noncontrast MRI after resection of a thoracic intradural metastasis (Th 1–3) and re-operation due to a spinal epidural haematoma. The images show an acute haematoma in the superior parts of the cerebellum, mainly on the right side. The bleeding has a streaky pattern, which is characteristic for a remote cerebellar haematoma [6, 10]

Fig. 2

Post-operative noncontrast MRI after draining of blood and CSF following intervertebral fusion and instrumentation as well as re-operation in the segment L3–L4. The pictures demonstrate two haemorrhages in the left cerebellar hemisphere and in the left temporo-occipital cortex

Fig. 3

Post-operative noncontrast CT after laminectomy and posterior instrumentation (L2–4) with considerable CSF loss due to several large dural tears. The scan reveals parieto-occipital cerebral haemorrhages as well as minor cerebellar bleedings on both sides. The presence of subdural air is due to the spinal dural opening. The bifrontal subdural CSF collections may be pre-existing hygromas or a consequence of CSF hypotension