Supratentorial subdural hemorrhage of a previous head injury and cerebellar hemorrhage after cervical spinal surgery: a case report and review of the literature.
METHODS
Case report.


OBJECTIVE
To report a case of an acute supratentorial subdural hemorrhage (SDH) of a previous head injury site and cerebellar hemorrhage, after an incidental dural tear during spine surgery.


BACKGROUND
Intracranial hemorrhage, such as subdural, cerebellar, subarachnoid, and epidural hemorrhage after a dural tear during spinal surgery, is a rare and poorly recognized complication. Moreover, only 3 cases in patients with concurrent SDH and cerebellar hemorrhage have been described in the literature, and none of these reports demonstrated the bleeding point on the adhesion site of the dural at the regions of the previous head injury.


METHODS
A case report and literature review are presented.


RESULTS
A 46-year-old male underwent occipital cervical surgery for os odontoideum. Intraoperatively, a dural tear was noted and repaired, but he later developed postoperative disturbance of consciousness. A head computed tomographic scan revealed a supratentorial SDH and cerebellar hemorrhage. Evacuation of the supratentorial SDH was performed via craniotomy, and the bleeding point was revealed to be on the adhesion site of the dural where the patient had experienced a previous head injury. The patient made a full recovery.


CONCLUSIONS
This report illustrates that cerebrospinal fluid leakage after a dural tear during spinal surgery may cause intracranial hemorrhage. A previous head trauma could be a risk factor for such hemorrhagic complications. Headache, nausea, and postoperative stupor after spinal surgery, especially after an accidental durotomy, should be considered possible indications of intracranial hemorrhage, and affected patients should be investigated with computed tomography or magnetic resonance imaging.


METHODS
N/A.
*Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan; and †Department of Orthopedic Surgery, Faculty of Medicine, Fukushima Medical University, School of Medicine, Fukushima, Japan.
Tadatsugu
T
Morimoto
Makoto
M
Shiraki
Koji
K
Otani
Motoki
M
Sonohata
Masaaki
M
Mawatari
D001268:Atlanto-Axial Joint / Q000601:surgery; D002526:Cerebellar Diseases / Q000175:diagnosis / Q000209:etiology*; D065634:Cerebrospinal Fluid Leak / Q000150:complications*; D006259:Craniocerebral Trauma / Q000150:complications*; D019299:Decompression, Surgical; D055191:Delayed Emergence from Anesthesia / Q000175:diagnosis; D003951:Diagnostic Errors; D004388:Dura Mater / Q000098:blood supply / Q000293:injuries*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology*; D007431:Intraoperative Complications; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D053608:Stupor / Q000209:etiology; D000267:Tissue Adhesions / Q000150:complications