Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights
Hemorrhage in regions remote from the site of initial intracranial operations is rare, but may be fatal. Postoperative cerebellar hemorrhage as a complication of supratentorial surgery, with a radiological appearance known as zebra sign, is an increasingly recognized clinical entity and is associate...
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| Veröffentlicht in: | Neurologia medico-chirurgica 2009, Vol.49(6), pp.229-234 |
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| creator | FIGUEIREDO, Eberval Gadelha Robson Luis Oliveira de AMORIM TEIXEIRA, Manoel Jacobsen |
| description | Hemorrhage in regions remote from the site of initial intracranial operations is rare, but may be fatal. Postoperative cerebellar hemorrhage as a complication of supratentorial surgery, with a radiological appearance known as zebra sign, is an increasingly recognized clinical entity and is associated mainly with vascular neurosurgery or temporal lobe resection. The pathophysiology remains unclear. Three cases of remote cerebellar hematoma occurred after neck clipping of anterior communicating artery aneurysms. All patients had similar clinical findings and underwent pterional craniotomy with the head in accentuated extension. One patient died and the two were discharged without symptoms. Cerebellar hemorrhage probably has a multifactorial origin involving positioning associated with abundant cerebrospinal fluid drainage causing cerebellar sag with resultant vein stretching and bleeding, and use of aspirin or other antiplatelet agents. |
| doi_str_mv | 10.2176/nmc.49.229 |
| format | Article |
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Postoperative cerebellar hemorrhage as a complication of supratentorial surgery, with a radiological appearance known as zebra sign, is an increasingly recognized clinical entity and is associated mainly with vascular neurosurgery or temporal lobe resection. The pathophysiology remains unclear. Three cases of remote cerebellar hematoma occurred after neck clipping of anterior communicating artery aneurysms. All patients had similar clinical findings and underwent pterional craniotomy with the head in accentuated extension. One patient died and the two were discharged without symptoms. Cerebellar hemorrhage probably has a multifactorial origin involving positioning associated with abundant cerebrospinal fluid drainage causing cerebellar sag with resultant vein stretching and bleeding, and use of aspirin or other antiplatelet agents.</description><identifier>ISSN: 0470-8105</identifier><identifier>EISSN: 1349-8029</identifier><identifier>DOI: 10.2176/nmc.49.229</identifier><identifier>PMID: 19556730</identifier><language>eng</language><publisher>Japan: The Japan Neurosurgical Society</publisher><subject>Aged ; anterior communicating artery ; Cerebellar Diseases - etiology ; Cerebellar Diseases - physiopathology ; cerebellum ; Cerebellum - blood supply ; Cerebellum - pathology ; Cerebellum - physiopathology ; Cerebral Angiography ; Cerebral Veins - diagnostic imaging ; Cerebral Veins - pathology ; Cerebral Veins - physiopathology ; Craniotomy - adverse effects ; Fatal Outcome ; Female ; Humans ; Hypotension, Orthostatic - complications ; Hypotension, Orthostatic - physiopathology ; Iatrogenic Disease ; intracranial aneurysm ; Intracranial Aneurysm - diagnostic imaging ; Intracranial Aneurysm - pathology ; Intracranial Aneurysm - surgery ; Intracranial Hemorrhage, Hypertensive - diagnostic imaging ; Intracranial Hemorrhage, Hypertensive - etiology ; Intracranial Hemorrhage, Hypertensive - physiopathology ; Intracranial Hemorrhages - diagnostic imaging ; Intracranial Hemorrhages - etiology ; Intracranial Hemorrhages - physiopathology ; Intracranial Hypotension - complications ; Intracranial Hypotension - physiopathology ; Intraoperative Care - adverse effects ; Middle Aged ; Neurosurgical Procedures - adverse effects ; pathophysiology ; Platelet Aggregation Inhibitors - adverse effects ; Postoperative Hemorrhage - etiology ; Postoperative Hemorrhage - physiopathology ; remote hemorrhage ; Tomography, X-Ray Computed ; Vascular Surgical Procedures - adverse effects ; Ventriculostomy - adverse effects</subject><ispartof>Neurologia medico-chirurgica, 2009, Vol.49(6), pp.229-234</ispartof><rights>2009 by The Japan Neurosurgical Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c670t-61448a8349e05d2ebcc1b4634e7b501513195a79b5c5b77b9b37e16c705589e53</citedby><cites>FETCH-LOGICAL-c670t-61448a8349e05d2ebcc1b4634e7b501513195a79b5c5b77b9b37e16c705589e53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,1877,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19556730$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FIGUEIREDO, Eberval Gadelha</creatorcontrib><creatorcontrib>Robson Luis Oliveira de AMORIM</creatorcontrib><creatorcontrib>TEIXEIRA, Manoel Jacobsen</creatorcontrib><title>Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights</title><title>Neurologia medico-chirurgica</title><addtitle>Neurol. Med. Chir.(Tokyo)</addtitle><description>Hemorrhage in regions remote from the site of initial intracranial operations is rare, but may be fatal. Postoperative cerebellar hemorrhage as a complication of supratentorial surgery, with a radiological appearance known as zebra sign, is an increasingly recognized clinical entity and is associated mainly with vascular neurosurgery or temporal lobe resection. The pathophysiology remains unclear. Three cases of remote cerebellar hematoma occurred after neck clipping of anterior communicating artery aneurysms. All patients had similar clinical findings and underwent pterional craniotomy with the head in accentuated extension. One patient died and the two were discharged without symptoms. Cerebellar hemorrhage probably has a multifactorial origin involving positioning associated with abundant cerebrospinal fluid drainage causing cerebellar sag with resultant vein stretching and bleeding, and use of aspirin or other antiplatelet agents.</description><subject>Aged</subject><subject>anterior communicating artery</subject><subject>Cerebellar Diseases - etiology</subject><subject>Cerebellar Diseases - physiopathology</subject><subject>cerebellum</subject><subject>Cerebellum - blood supply</subject><subject>Cerebellum - pathology</subject><subject>Cerebellum - physiopathology</subject><subject>Cerebral Angiography</subject><subject>Cerebral Veins - diagnostic imaging</subject><subject>Cerebral Veins - pathology</subject><subject>Cerebral Veins - physiopathology</subject><subject>Craniotomy - adverse effects</subject><subject>Fatal Outcome</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension, Orthostatic - complications</subject><subject>Hypotension, Orthostatic - physiopathology</subject><subject>Iatrogenic Disease</subject><subject>intracranial aneurysm</subject><subject>Intracranial Aneurysm - diagnostic imaging</subject><subject>Intracranial Aneurysm - pathology</subject><subject>Intracranial Aneurysm - surgery</subject><subject>Intracranial Hemorrhage, Hypertensive - diagnostic imaging</subject><subject>Intracranial Hemorrhage, Hypertensive - etiology</subject><subject>Intracranial Hemorrhage, Hypertensive - physiopathology</subject><subject>Intracranial Hemorrhages - diagnostic imaging</subject><subject>Intracranial Hemorrhages - etiology</subject><subject>Intracranial Hemorrhages - physiopathology</subject><subject>Intracranial Hypotension - complications</subject><subject>Intracranial Hypotension - physiopathology</subject><subject>Intraoperative Care - adverse effects</subject><subject>Middle Aged</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>pathophysiology</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Postoperative Hemorrhage - etiology</subject><subject>Postoperative Hemorrhage - physiopathology</subject><subject>remote hemorrhage</subject><subject>Tomography, X-Ray Computed</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Ventriculostomy - adverse effects</subject><issn>0470-8105</issn><issn>1349-8029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkF1LwzAUhoMobszd-AMklyp0Jk3SNN6IDHWDoeLXhTclyc7aSteOpL3Yvzejc96cA-c8vLw8CJ1TMompTG7qtZ1wNYljdYSGlHEVpSRWx2hIuCRRSokYoLH3pSEk5ilnqTxFA6qESCQjQ5S9wbppAU_BgYGq0g7PwsW5QueAL7_BOI3fy7y-wmWNv7S33Y55hs41vnM5uO0tftVt0WyKrS-bqslLqys8r32ZF60_QycrXXkY7_cIfT4-fExn0eLlaT69X0Q2kaSNEsp5qtNQH4hYxmCspYYnjIM0glBBWaispTLCCiOlUYZJoImVRIhUgWAjdN3n2tDLO1hlG1eutdtmlGQ7UVkQlXGVBVEBvujhTWfWsPxH91oCcNcDP74NHg6Adm1pK_jLSvoRIg8fW2iXQc1-AZbBeuk</recordid><startdate>2009</startdate><enddate>2009</enddate><creator>FIGUEIREDO, Eberval Gadelha</creator><creator>Robson Luis Oliveira de AMORIM</creator><creator>TEIXEIRA, Manoel Jacobsen</creator><general>The Japan Neurosurgical Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>2009</creationdate><title>Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights</title><author>FIGUEIREDO, Eberval Gadelha ; Robson Luis Oliveira de AMORIM ; TEIXEIRA, Manoel Jacobsen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c670t-61448a8349e05d2ebcc1b4634e7b501513195a79b5c5b77b9b37e16c705589e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>anterior communicating artery</topic><topic>Cerebellar Diseases - etiology</topic><topic>Cerebellar Diseases - physiopathology</topic><topic>cerebellum</topic><topic>Cerebellum - blood supply</topic><topic>Cerebellum - pathology</topic><topic>Cerebellum - physiopathology</topic><topic>Cerebral Angiography</topic><topic>Cerebral Veins - diagnostic imaging</topic><topic>Cerebral Veins - pathology</topic><topic>Cerebral Veins - physiopathology</topic><topic>Craniotomy - adverse effects</topic><topic>Fatal Outcome</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension, Orthostatic - complications</topic><topic>Hypotension, Orthostatic - physiopathology</topic><topic>Iatrogenic Disease</topic><topic>intracranial aneurysm</topic><topic>Intracranial Aneurysm - diagnostic imaging</topic><topic>Intracranial Aneurysm - pathology</topic><topic>Intracranial Aneurysm - surgery</topic><topic>Intracranial Hemorrhage, Hypertensive - diagnostic imaging</topic><topic>Intracranial Hemorrhage, Hypertensive - etiology</topic><topic>Intracranial Hemorrhage, Hypertensive - physiopathology</topic><topic>Intracranial Hemorrhages - diagnostic imaging</topic><topic>Intracranial Hemorrhages - etiology</topic><topic>Intracranial Hemorrhages - physiopathology</topic><topic>Intracranial Hypotension - complications</topic><topic>Intracranial Hypotension - physiopathology</topic><topic>Intraoperative Care - adverse effects</topic><topic>Middle Aged</topic><topic>Neurosurgical Procedures - adverse effects</topic><topic>pathophysiology</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Postoperative Hemorrhage - etiology</topic><topic>Postoperative Hemorrhage - physiopathology</topic><topic>remote hemorrhage</topic><topic>Tomography, X-Ray Computed</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Ventriculostomy - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FIGUEIREDO, Eberval Gadelha</creatorcontrib><creatorcontrib>Robson Luis Oliveira de AMORIM</creatorcontrib><creatorcontrib>TEIXEIRA, Manoel Jacobsen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Neurologia medico-chirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FIGUEIREDO, Eberval Gadelha</au><au>Robson Luis Oliveira de AMORIM</au><au>TEIXEIRA, Manoel Jacobsen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights</atitle><jtitle>Neurologia medico-chirurgica</jtitle><addtitle>Neurol. Med. Chir.(Tokyo)</addtitle><date>2009</date><risdate>2009</risdate><volume>49</volume><issue>6</issue><spage>229</spage><epage>234</epage><pages>229-234</pages><issn>0470-8105</issn><eissn>1349-8029</eissn><abstract>Hemorrhage in regions remote from the site of initial intracranial operations is rare, but may be fatal. Postoperative cerebellar hemorrhage as a complication of supratentorial surgery, with a radiological appearance known as zebra sign, is an increasingly recognized clinical entity and is associated mainly with vascular neurosurgery or temporal lobe resection. The pathophysiology remains unclear. Three cases of remote cerebellar hematoma occurred after neck clipping of anterior communicating artery aneurysms. All patients had similar clinical findings and underwent pterional craniotomy with the head in accentuated extension. One patient died and the two were discharged without symptoms. Cerebellar hemorrhage probably has a multifactorial origin involving positioning associated with abundant cerebrospinal fluid drainage causing cerebellar sag with resultant vein stretching and bleeding, and use of aspirin or other antiplatelet agents.</abstract><cop>Japan</cop><pub>The Japan Neurosurgical Society</pub><pmid>19556730</pmid><doi>10.2176/nmc.49.229</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | J-STAGE Free; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged anterior communicating artery Cerebellar Diseases - etiology Cerebellar Diseases - physiopathology cerebellum Cerebellum - blood supply Cerebellum - pathology Cerebellum - physiopathology Cerebral Angiography Cerebral Veins - diagnostic imaging Cerebral Veins - pathology Cerebral Veins - physiopathology Craniotomy - adverse effects Fatal Outcome Female Humans Hypotension, Orthostatic - complications Hypotension, Orthostatic - physiopathology Iatrogenic Disease intracranial aneurysm Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - pathology Intracranial Aneurysm - surgery Intracranial Hemorrhage, Hypertensive - diagnostic imaging Intracranial Hemorrhage, Hypertensive - etiology Intracranial Hemorrhage, Hypertensive - physiopathology Intracranial Hemorrhages - diagnostic imaging Intracranial Hemorrhages - etiology Intracranial Hemorrhages - physiopathology Intracranial Hypotension - complications Intracranial Hypotension - physiopathology Intraoperative Care - adverse effects Middle Aged Neurosurgical Procedures - adverse effects pathophysiology Platelet Aggregation Inhibitors - adverse effects Postoperative Hemorrhage - etiology Postoperative Hemorrhage - physiopathology remote hemorrhage Tomography, X-Ray Computed Vascular Surgical Procedures - adverse effects Ventriculostomy - adverse effects |
| title | Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights |
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