Bilateral Late Remote Cerebellar Hemorrhage as a Complication of a Lumbo-Peritoneal Shunt Applied After Spinal Arteriovenous Malformation Surgery

Abstract

Background/Objective: Cerebellar hemorrhage is a very infrequent and unpredictable complication of spinal surgery. To the best of our knowledge, cerebellar hemorrhage resulting from the insertion of a lumbo-peritoneal shunt through which cerebrospinal fluid (CSF) is slowly drained has not been documented to date.

Methods: Case report.

Results: A 47-year-old woman presented with lower extremity weakness. Spinal arteriovenous malformation was diagnosed, and she underwent surgery. Her neurologic status improved; however, CSF collected subcutaneously as a cyst and leaked 21 days after surgery. The patient underwent urgent surgery during which the durai defect was repaired and a lumbo-peritoneal catheter was put in place to treat the CSF leakage. The lumbo-peritoneal drainage system was removed when bilateral cerebellar hemorrhage was seen 12 days later. Physical therapy was stopped, and conservative treatment was initiated consisting of bed rest, analgesics, sedatives, and careful monitoring of blood pressure. The patient's headache gradually resolved; physical therapy was restarted to rehabilitate this patient with paraparesis.

Conclusions: Remote cerebellar hemorrhage seems to be life threatening and entails significant morbidity. Cerebellar symptoms, and even a late sudden headache after spinal surgery, may be signs of remote cerebellar hemorrhage, which is a rare complication.

J Spinal Cord Med. February 2010; 33(1): 77–79

Key Words:

• Cerebellar hemorrhage
• Spinal arteriovenous malformation
• Paraparesis
• Cerebrospinal fluid
• Lumbo-peritoneal shunt
• Spinal surgery