November 2021



Case history

•An elderly woman presented with complaints of progressive diminution of vision in both eyes.

•MRI showed suprasellar meningioma impinging on the optic chiasm.

•Patient underwent excision of the mass .

•Post operatively the patient did not wake up from anaesthesia.

•CT scan was ordered to look for post-operative complications. • •

Case contributed by –

1.Dr Keerthinarayan M,

2.Dr.Vandana Peruri,

3.Dr.Hashim ,



Department of Radiology and Imaging ; Apollo Hospital, Sheshadripuram, Bengaluru.

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Case of the month NovCase of the month Nov
Fig. 1
Case of the month Nov 2021Case of the month Nov 2021Case of the month Nov 2021
Fig. 2

Immediate check  CT head (Plain)


A well defined T1 iso,T2 mildly hyperintense lesion showing intense contrast enhancement is seen in the suprasellar cistern encasing bilateral cavernous ICA and impinging optic chiasma and prechiasmatic segment of bilateral optic nerves.

Images of CT scan of brain axial(a),sagittal (b)and coronal (c) sections show  hyperdense blood layering  the subarachnoid spaces  along the cerebellar folia (pointed by arrows).

Remote cerebellar hemorrhage

“Zebra sign” - Layering of blood along the
cerebellar folia

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 infarction1,2.

(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.


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 Neurochirurgica1987;88(3-4):104–108

This Post Has 3 Comments

  1. Manoj

    Remote cerebellar hemorrhage due to hemorrhagic venous infarction

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