Three patients with remote cerebellar hemorrhage following supratentorial cerebrovascular surgery are presented. [ncbi.nlm.nih.gov]

• Unconsciousness

  Sedation was withheld but he remained unconscious; both the pupils were round and reactive to light. He localized to stimulation with the upper extremities. [cureus.com]

  On examination she was unconscious, not opening her eyes to pain, and only localizing to deep central pain with both upper limbs. Her pupils were bilaterally equal and sluggishly reacting to light. [asianjns.org]

• Vomiting

  Such a complication is rare but should be considered after foramen magnum decompression surgery if the patient shows unusual symptoms of repeated vomiting. [ncbi.nlm.nih.gov]

  On examination, he was disclosed mental confusion, repeated vomiting, constricred pupil, horizontal nystagmus, inability to stand, dysarthria and neck stiffness. [jkns.or.kr]

• Nausea

  The patient complained of severe headache and nausea postoperatively. Brain computed tomography obtained 3 days after the surgery demonstrated remote cerebellar hemorrhage and hydrocephalus. [ncbi.nlm.nih.gov]

• Vascular Disease

  disease Birth trauma Transient ischemic attack (TIA) Hydrocephalus Cerebellar ataxia Cerebellar degeneration CT : accurate for cerebellar hemorrhage; to determine need for surgical evacuation Neurovascular tests Neck flexion for meningeal irritation [accessphysiotherapy.mhmedical.com]

  Historical note and terminology Infarction and hemorrhage are at different ends of the spectrum of vascular disease of the cerebellum; they share clinical features and some management strategies; therefore, they will be reviewed together. [medlink.com]

  View Article PubMed Google Scholar Adams HP, Biller J: Hemorrhagic intracranial vascular disease. Clinical Neurology. Edited by: Joynt RJ, Griggs RC. 1993, Philadelphia: Lippincott-Raven Publishers, 2: 1-49. [jmedicalcasereports.com]

• Miosis

  […] disturbances are deviation of the eyes downward & inward so that they appear to be looking at the pt's nose, unequal pupils with absence of light reaction, skew deviation with the eye opposite the hemorrhage displaced downward & medially, ipsilateral ptosis & miosis [enotes.tripod.com]

• Withdrawn

  After discussion with the patient's family, life-sustaining support measures were withdrawn. Postmortem analysis revealed a low FVIII activity level and the presence of FVIII inhibitor. [ncbi.nlm.nih.gov]

• Headache

  Cerebellar symptoms, and even a late sudden headache after spinal surgery, may be signs of remote cerebellar hemorrhage, which is a rare complication. [ncbi.nlm.nih.gov]

• Ataxia

  The neurological examination showed ataxia, myoclonus and dystonia in the right upper extremity. Brain images demonstrated a hemorrhage in the right cerebellar hemisphere secondary to a cavernous malformation. [ncbi.nlm.nih.gov]

• Dizziness

  The wound was healing well and headache and dizziness also improved. He was discharged from the hospital on the 30 th day. [synapse.koreamed.org]

  Twelve hours after spinal surgery, she complained of unexpected dizziness, nausea, and vomiting. A total of 850 mL of serosanguineous fluid had been drained at that time, and drainage was stopped. [ncbi.nlm.nih.gov]

  They frequently present with headache, nausea and vomiting, dizziness, and a striking difficulty standing or walking. [medlink.com]

• Nystagmus

  Abstract A 63-year-old woman presented with a metastatic focus of papillary thyroid carcinoma in the cerebellopontine angle manifesting as lateral gazing nystagmus and slurred speech. [ncbi.nlm.nih.gov]

  Cerebellar signs (e.g. ataxia, nystagmus) 1. Larger bleeds can impair consciousness and obstruct the fourth ventricle resulting in obstructive hydrocephalus. [radiopaedia.org]

  On examination, he was disclosed mental confusion, repeated vomiting, constricred pupil, horizontal nystagmus, inability to stand, dysarthria and neck stiffness. [jkns.or.kr]

• Dysarthria

  The first patient was treated conservatively and had mild residual dysarthria and gait ataxia 2 months after surgery. The second patient underwent exploration and revision of the lumbar wound with primary dural repair. [ncbi.nlm.nih.gov]

  On examination, he was disclosed mental confusion, repeated vomiting, constricred pupil, horizontal nystagmus, inability to stand, dysarthria and neck stiffness. [jkns.or.kr]

  Most prominent feature of acute cerebellar stroke is repeated vomiting Patient will experience occipital headache, vertigo, difficulty remaining upright, walking Most cases show mild unilateral facial weakness and decreased corneal reflex May exhibit dysarthria [accessphysiotherapy.mhmedical.com]

This case series will hopefully shed further light on the incidence, presentation, workup, and treatment of this particular complication of supratentorial surgery. [nebraska.pure.elsevier.com]

In patients with remote site bleed, workup of complete coagulation profile before surgical intervention is highly warranted, Decision to evacuate remote site hematoma should be tailored based on clinical, radiological, and coagulation profile. [neurologyindia.com]

Preoperative identification and workup of the coagulation abnormality is essential to guide initial treatment. In our study, ETV was performed in one patient as an alternative procedure where the intact CSF pathways were emphasized. [tdj.eg.net]

• Hyperglycemia

  We aimed to determine the association of hyperglycemia on admission with 6-month functional outcome in CH patients. [ncbi.nlm.nih.gov]

  The results revealed that increased HR, hyperglycemia, increased ICH score, and decreased PC at admission are prognostic indicators of poor outcome at discharge in spontaneous CH. [journals.plos.org]

  Surgical Neurology, 55, 156-161. http://dx.doi.org/10.1016/S0090-3019(01)00347-0 [ 4 ] Wu, Y.T., Li, T.Y., Lu, S., Chen, L.C., Chu, H.Y., Chiang, S.L., et al. (2012) Hyperglycemia as a Predictor of Poor Outcome at Discharge in Patients with Acute Spontaneous [scirp.org]

Treatment consisted in external ventricular drainage in case 1 and conservative treatment in case 2. Both patients recovered without major neurological deficits. [ncbi.nlm.nih.gov]

This case series will hopefully shed further light on the incidence, presentation, workup, and treatment of this particular complication of supratentorial surgery. [nebraska.pure.elsevier.com]

Prognosis depends largely on the severity of this bleeding. [ncbi.nlm.nih.gov]

Treatment and prognosis Unlike pontine hemorrhages, cerebellar hemorrhages carry a relatively good prognosis if timely evacuation and control of hydrocephalus can be obtained. Prompt diagnosis and neurosurgical referral are therefore key. [radiopaedia.org]

The first patient was asymptomatic and had a good prognosis, however, the second one was symptomatic and demonstrated deterioration and had a poor prognosis. [surgicalneurologyint.com]

Investigation for etiology of the hemorrhage included an MRI showing extensive subcortical ischemic disease and also several previous microbleeds. [ncbi.nlm.nih.gov]

Aneurysmal subarachnoid hemorrhage: Epidemiology, risk factors, and pathogenesis. https://www.uptodate.com/contents/search. Accessed May 6, 2022. Dubosh NM, et al. Diagnosis and initial emergency department management of subarachnoid hemorrhage. [mayoclinic.org]

Epidemiology Frequency United States An estimated 10% of intracerebral hemorrhages are believed to be cerebellar in location. An estimated 1-2% of strokes are CHs. [emedicine.medscape.com]

Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México. b Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México. c Department of Epidemiology [j-stroke.org]

View Article PubMed Google Scholar Thrift AG, Donnan GA, McNeil JJ: Epidemiology of intracerebral hemorrhage. Epidemiol Rev. 1995, 17 (2): 361-381. PubMed Google Scholar Auer RN, Sutherland GR: Primary intracerebral hemorrhage: pathophysiology. [jmedicalcasereports.com]

Severe congestion of upper cerebellar veins seemed to be a possible pathophysiology of this specific bleeding pattern. [ncbi.nlm.nih.gov]

We report a patient, having used aspirin for secondary stroke prevention, who had an acute cerebellar hemorrhage after taking nattokinase 400 mg daily for 7 consecutive days. [ncbi.nlm.nih.gov]