Hidden hazard of remote cerebellar hemorrhage after cervical spine surgery: Case report

Remote cerebellar hemorrhage (RCH) is a rare but potentially serious complication of spinal surgery, particularly after decompressive procedures and instrumented fusion. The complex interplay between cerebrospinal fluid leaks and hemorrhage risk necessitates a high index of suspicion and prompt management to optimize patient outcomes.

We present a case of RCH in a 50-year-old man with hypertension, non-insulin dependent diabetes mellitus, and cervical myeloradiculopathy following a C3-C6 laminectomy with posterior instrumented fusion. Despite an initially benign presentation, the patient developed severe positional headaches, nausea, vomiting, and lethargy. A head CT on postoperative day five revealed a right cerebellar hemispheric hemorrhage with obstructive hydrocephalus. Intensive care management, including strict blood pressure control, serial neuroimaging, and close neurological monitoring, led to hemorrhage stabilization and discharge on postoperative day 18.

RCH is believed to result from venous infarction secondary to rapid cerebrospinal fluid loss, often associated with dural tears. Even minor cerebrospinal fluid leaks can precipitate significant complications, underscoring the importance of early recognition and tailored management. Patient positioning and subfascial drainage strategies during surgery should be optimized to mitigate risks, and vigilant postoperative monitoring is critical for timely intervention.

This case underscores the importance of meticulous surgical technique, vigilant postoperative care, and the judicious use of imaging in managing RCH. It also highlights that radiographic severity does not always dictate the need for aggressive surgical intervention and emphasizes the significance of recognizing postoperative headaches as a potential sign of intracranial bleeding.