Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss

2005 ◽  
Vol 102 (6) ◽  
pp. 1159-1162 ◽  
Author(s):  
Marc A. Brockmann ◽  
Georg Nowak ◽  
Erich Reusche ◽  
Martin Russlies ◽  
Dirk Petersen
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Loss ◽  
Bleeding Pattern ◽  
Cerebellar Hemorrhage ◽  
Content Type ◽  
Zebra Pattern ◽  
Remote Cerebellar Hemorrhage ◽  
Pattern Characteristic ◽  
Zebra Sign ◽  
Almost All

✓ Supratentorial subdural hematoma is a well-known complication following spinal interventions. Less often, spinal or supratentorial interventions cause remote cerebellar hemorrhage (RCH). The exact pathomechanism accounting for RCH remains unclear, but an interventional or postinterventional loss of cerebrospinal fluid (CSF) seems to be involved in almost all cases. Hemorrhage is often characterized by a typical, streaky bleeding pattern due to blood spreading in the cerebellar sulci. Three different cases featuring this bleeding pattern following spinal, supratentorial, and thoracic surgery are presented. Possible pathomechanisms leading to RCH are discussed. Based on data from the underlying cases and the reviewed literature, the authors concluded that this zebra-pattern hemorrhage seems to be typical in a postoperative loss of CSF, which should always be considered on presentation of this bleeding pattern.

scholarly journals Remote Cerebellar Hemorrhage (Zebra Sign) in Vascular Neurosurgery: Pathophysiological Insights

2009 ◽  
Vol 49 (6) ◽  
pp. 229-234 ◽  
Author(s):  
Eberval Gadelha FIGUEIREDO ◽  
Robson Luis Oliveira de AMORIM ◽  
Manoel Jacobsen TEIXEIRA
Keyword(s):  
Cerebellar Hemorrhage ◽  
Remote Cerebellar Hemorrhage ◽  
Zebra Sign ◽  
Vascular Neurosurgery

scholarly journals Remote Cerebellar Hemorrhage after Removal of Large Convexity Meningioma

2020 ◽  
Vol 17 (3) ◽  
pp. 63-67
Author(s):  
Dinuj Shrestha ◽  
Janam Shrestha ◽  
Pravesh Rajbhandari ◽  
Resha Shrestha ◽  
Basant Pant
Keyword(s):  
Cerebrospinal Fluid ◽  
Postoperative Complication ◽  
Benign Condition ◽  
Cerebellar Hemorrhage ◽  
Remote Cerebellar Hemorrhage ◽  
Supratentorial Craniotomy

Remote cerebellar hemorrhage is a rare postoperative complication. It can occur after infratentorial or supratentorial craniotomies, later being more common. Remote cerebellar hemorrhage is considered to be a self-limited and benign condition. The exact pathophysiology of remote cerebellar hemorrhage remains unclear, but reports have suggested an association with excessive loss of cerebrospinal fluid. We report a case of remote cerebellar hemorrhage after supratentorial craniotomy for large convexity meningioma without excessive loss of cerebrospinal fluid.

Cerebellar Hemorrhage after Spinal Surgery: Report of Two Cases and Literature Review

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1361-1364 ◽  
Author(s):  
Jonathan A. Friedman ◽  
Robert D. Ecker ◽  
David G. Piepgras ◽  
Derek A. Duke
Keyword(s):  
Cerebrospinal Fluid ◽  
Prone Position ◽  
Spinal Surgery ◽  
Right Hemisphere ◽  
Patient Positioning ◽  
Herniated Disc ◽  
Neurosurgical Procedures ◽  
Causative Role ◽  
Cerebellar Hemorrhage ◽  
Remote Cerebellar Hemorrhage

Abstract OBJECTIVE AND IMPORTANCE Cerebellar hemorrhage remote from the site of surgery may complicate neurosurgical procedures. We describe our experience with two cases of cerebellar hemorrhage after spinal surgery and review the three cases previously reported in the literature to determine whether these cases provide insight regarding the pathogenesis of remote cerebellar hemorrhage. CLINICAL PRESENTATION One of our patients developed cerebellar hemorrhage in the vermis and right hemisphere after transpedicular removal of a partially intradural T9–T10 herniated disc with the patient in the prone position. The other patient developed cerebellar hemorrhage in the vermis and bilateral hemispheres after L3–S1 decompression and instrumentation with the patient in the prone position, during which the dura was inadvertently opened. INTERVENTION 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. The cerebellar hemorrhage was treated conservatively, and the patient had mild dysarthria and ataxia 1 month after surgery. CONCLUSION Cerebellar hemorrhage must be considered in patients with unexplained neurological deterioration after spinal surgery. Dural opening with loss of cerebrospinal fluid has occurred in every reported case of cerebellar hemorrhage complicating a spinal procedure, supporting the hypothesis that loss of cerebrospinal fluid is central to the pathogenesis of this condition. Because remote cerebellar hemorrhage can occur after procedures with the patient in the supine, sitting, and prone positions, patient positioning seems unlikely to play a causative role in its occurrence.

scholarly journals Remote Cerebellar Hemorrhage after Frontal Lobectomy: Zebra Sign

2014 ◽  
Vol 04 (04) ◽  
pp. 181-185
Author(s):  
Can Yaldiz ◽  
Volkan Murat Unal ◽  
Omer Akar ◽  
Onur Yaman ◽  
Nail Ozdemir
Keyword(s):  
Cerebellar Hemorrhage ◽  
Remote Cerebellar Hemorrhage ◽  
Zebra Sign ◽  
Frontal Lobectomy

Lumbosacral intersegmental epispinal axons and ectopic ventral nerve rootlets

1987 ◽  
Vol 67 (2) ◽  
pp. 269-277 ◽  
Author(s):  
Wesley W. Parke ◽  
Ryo Watanabe
Keyword(s):  
Nerve Root ◽  
Sensory Nerve ◽  
Conus Medullaris ◽  
Spinal Nerve ◽  
Nerve Fibers ◽  
Ventral Horn ◽  
Spinal Nerve Roots ◽  
Nerve Roots ◽  
Content Type ◽  
Almost All

✓ An epispinal system of motor axons virtually covers the ventral and lateral funiculi of the human conus medullaris between the L-2 and S-2 levels. These nerve fibers apparently arise from motor cells of the ventral horn nuclei and join spinal nerve roots caudal to their level of origin. In all observed spinal cords, many of these axons converged at the cord surface and formed an irregular group of ectopic rootlets that could be visually traced to join conventional spinal nerve roots at one to several segments inferior to their original segmental level; occasional rootlets joined a dorsal nerve root. As almost all previous reports of nerve root interconnections involved only the dorsal roots and have been cited to explain a lack of an absolute segmental sensory nerve distribution, it is believed that these intersegmental motor fibers may similarly explain a more diffuse efferent distribution than has previously been suspected.

Applicability of the DUNDRUM-1 in a forensic Belgium setting

2019 ◽  
Vol 21 (1) ◽  
pp. 85-94 ◽  
Author(s):  
Petra Habets ◽  
Inge Jeandarme ◽  
Harry G. Kennedy
Keyword(s):  
Repeated Measurements ◽  
Security Level ◽  
Rater Reliability ◽  
Content Type ◽  
Forensic Patients ◽  
Item Level ◽  
Dundrum Toolkit ◽  
Male Patients ◽  
Receive Treatment ◽  
Almost All

Purpose Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal and few instruments are available. The DUNDRUM toolkit is a structured clinical judgement instrument that can be used to provide support when determining security level. The purpose of this paper is to investigate the applicability and validity of the DUNDRUM-1 in Flanders. Design/methodology/approach The DUNDRUM-1 was scored for 50 male patients admitted at the forensic units in the public psychiatric hospital Rekem. Some files were rated by three researchers who were blind to participants’ security status, resulting in 33 double measurements. Findings Almost all files (96 per cent) contained enough information to score the DUNDRUM-1. Average DUNDRUM-1 final judgement scores were concordant with a medium security profile. No difference was found between the current security levels and the DUNDRUM-1 final judgement scores. Inter-rater reliability was excellent for the DUNDRUM-1 final judgement scores. On item level, all items had excellent to good inter-rater reliability with the exception of one item institutional behaviour which had an average inter-rater reliability. Practical implications The DUNDRUM-1 can be a useful tool in Flemish forensic settings. It has good psychometric properties. More research is needed to investigate the relationship between DUNDRUM-1 scores and security level decisions by the courts. Originality/value This is the first study that investigated the applicability of the DUNDRUM-1 in a Belgian setting, also a relative large number of repeated measurements were available to investigate the inter-rater reliability of the DUNDRUM-1.

Recurrent intracranial solitary fibrous tumor with cerebrospinal fluid dissemination

2004 ◽  
Vol 101 (6) ◽  
pp. 1045-1048 ◽  
Author(s):  
Katsuyoshi Miyashita ◽  
Yutaka Hayashi ◽  
Hironori Fujisawa ◽  
Mitsuhiro Hasegawa ◽  
Junkoh Yamashita
Keyword(s):  
Cerebrospinal Fluid ◽  
Malignant Transformation ◽  
Solitary Fibrous Tumor ◽  
S100 Protein ◽  
Spinal Tumors ◽  
Content Type ◽  
Csf Dissemination ◽  
Fibrous Tumor ◽  
Fine Print ◽  
Mib 1

✓ Solitary fibrous tumor (SFT) is a benign and rare neoplasm. To date, only 37 patients with intracranial SFTs have been reported. Although a number of the tumors were recurrent and some later underwent malignant transformation, none of these lesions progressed to cerebrospinal fluid (CSF) dissemination. In this paper the authors report a case of SFT in which the lesion recurred several times and ultimately was disseminated by the CSF. The patient was a 63-year-old woman with multiple intracranial and spinal tumors. Fifteen years before this presentation, at the age of 48 she had been hospitalized for resection of a falcotentorial tumor. During the ensuing 15 years she underwent multiple surgeries and sessions of radiation therapy for recurrent lesions. The exclusive location of her tumors in the subarachnoid space at the end of this 15-year period indicate CSF dissemination of the tumor. The tumor that was resected when the patient was 48 years old and the latest resected lesion were analyzed by performing immunohistological CD34, epithelial membrane antigen, vimentin, S100 protein, and reticulin staining, and determining the MIB-1 labeling index (LI). Most of the results were identical, and both tumors were diagnosed as SFT according to a staining pattern that showed a strong and diffuse positive reaction for CD34. Nevertheless, the authors noted that the MIB-1 LI increased from less than 1% in the original tumor to 13% in the latest tumor. The increased proliferation of MIB-1 indicates that the malignant transformation could have occurred during tumor recurrence with CSF dissemination.

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