Remote cerebellar hemorrhage(RCH) is a rare but benign complication of the supratentorial and spine surgeries ¹. It is called remote as the hemorrhage occurs distant from the site of surgery.

Most patients are asymptomatic. Other symptoms are of RCH are decreased level of consciousness, motor deficits, gait ataxia, and prolonged awakening from anesthesia as in our case ¹. Many risk factors have been associated with RCH such as hypertension, epilepsy, compromised coagulation status, excess CSF loss during and after surgery and old age².

Mechanism of occurrence is not well understood however the following hypotheses are proposed:

(a). Supratentorial procedures that involve opening of cisterns or ventricular systems with patients in a supine position may lead to opening of cisterns and the ventricular system causing CSF hypovolemia resulting in cerebellar sagging. This may cause transient occlusion of  superior bridging veins of the posterior fossa leading to subsequent hemorrhagic infarction^1,2.

(b). In contrast, some have theorized that increased pressure gradients across veins generated after removal of space occupying lesions such as tumors may lead to RCH ³.

REFERENCES

1. Amini A, Osborn AG, Mccall TD et-al. Remote cerebellar hemorrhage. Americal  Journal of Neuroradiology. 2006;27 (2): 387-90.

2. Omer A, Engelman E, Bath K, Krauthamer A, Pisinski L. Remote cerebellar hemorrhage: A case report. Radiology Case Reports. 2019;14(3):385-389.

3.  Konig A., Laas R., Herrmann H.D. Cerebellar haemorrhage as a complication after supratentorial craniotomy. Acta Neurochirurgica. 1987;88(3-4):104–108