title: Multiple cerebellar hemorrhagic infarctions following surgery for a huge atlantoaxial neurinoma.
abstract: BACKGROUND
  There have been only five reported cases with cerebellar hemorrhagic infarction after spinal surgery, and the underlying pathomechanism remains obscure.
  
  
  OBJECTIVE
  To describe a case with multiple cerebellar hemorrhagic infarctions after surgery for a huge atlantoaxial neurinoma.
  
  
  METHODS
  Case report
  
  
  METHODS
  A 36-year-old man underwent uneventful surgery for a huge atlantoaxial neurinoma. After surgery, the patient was lethargic with slurred speech and subsequently developed cerebellar symptoms, although preoperative myelopathic symptoms did not worsen. The clinical and radiological findings are presented, and possible causes of the hemorrhages are discussed.
  
  
  RESULTS
  Magnetic resonance imaging of the brain after surgery showed multiple cerebellar hemorrhagic infarctions. However, magnetic resonance angiography revealed no occlusion or stenosis in the vertebrobasilar system, and a duplex scan of the neck vessels confirmed normal flow in the vertebral arteries after surgery. In response to the conservative treatment, the patient exhibited neurological recovery with disappearance of cerebellar symptoms.
  
  
  CONCLUSIONS
  In the present case with multiple cerebellar hemorrhagic infarctions, venous infarction appears more likely to be the cause of cerebellar hemorrhagic infarction than arterial infarction. The most likely underlying pathomechanism is a cerebellar venous disturbance precipitated by loss of a large amount of cerebrospinal fluid, although the exact etiology remains elusive.
authors.affiliation: Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. sakaurah@ort.med.osaka-u.ac.jp
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sakaura
authors.forename: Noboru
authors.initials: N
authors.lastname: Hosono
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mukai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ishii
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint; D020520:Brain Infarction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002526:Cerebellar Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods; D018810:Magnetic Resonance Angiography; D008297:Male; D009367:Neoplasm Staging; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D018570:Risk Assessment; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000601:surgery*