title: Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss. Case report.
abstract: Supratentorial subdural hematoma is a well-known complication following spinal interventions. Less often, spinal or supratentorial interventions cause remote cerebellar hemorrhage (RCH). The exact pathomechanism accounting for RCH remains unclear, but an interventional or postinterventional loss of cerebrospinal fluid (CSF) seems to be involved in almost all cases. Hemorrhage is often characterized by a typical, streaky bleeding pattern due to blood spreading in the cerebellar sulci. Three different cases featuring this bleeding pattern following spinal, supratentorial, and thoracic surgery are presented. Possible pathomechanisms leading to RCH are discussed. Based on data from the underlying cases and the reviewed literature, the authors concluded that this zebra-pattern hemorrhage seems to be typical in a postoperative loss of CSF, which should always be considered on presentation of this bleeding pattern.
authors: Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Luebeck, Germany. brockmann@gmx.de
authors: Marc A
authors: MA
authors: Brockmann
authors: Georg
authors: G
authors: Nowak
authors: Erich
authors: E
authors: Reusche
authors: Martin
authors: M
authors: Russlies
authors: Dirk
authors: D
authors: Petersen
mesh_terms: D000208:Acute Disease; D000328:Adult; D002531:Cerebellum / Q000098:blood supply; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D002555:Cerebrospinal Fluid / Q000378:metabolism*; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D010178:Pancoast Syndrome / Q000601:surgery; D011183:Postoperative Complications; D013122:Spinal Diseases / Q000601:surgery; D014057:Tomography, X-Ray Computed