Multiple cerebellar hemorrhagic infarctions following surgery for a huge atlantoaxial neurinoma.
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.
Sakaura
Hironobu
H
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. sakaurah@ort.med.osaka-u.ac.jp
Hosono
Noboru
N
Mukai
Yoshihiro
Y
Ishii
Takahiro
T
Yoshikawa
Hideki
H
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*