Presentation
Patient presented to the ER department refering low back pain and impaired function. Initially diagnosed with retrolisthesis of L2-L3 and left foraminal narrowing, underwent decompressive surgery and subsequent procedure of pedicle screws revision and left foraminotomy. Complaints of headache worsened by opening of the suction drain and altered state of consciousness was observed, suspected of cerebrospinal fluid leak.
Patient Data
CT brain showing bilateral, almost symmetrical subarachnoid hemorrhage in the sulci of the cerebellar folia, also known as "zebra sign".
Focus of hemorrhage, apparently intraparenchymal, measuring 10 mm, in the right temporal lobe.
Case Discussion
Key learning points:
non-contrast CT brain is the most efficient method of evaluation 1
intracranial hemorrhage after spinal surgery is one of the most common and important complications in neurosurgery, secondary to cerebrospinal fluid leakage and subsequent increase in the transluminal venous pressure, resulting in blood vessel rupture 2
the common presenting symptom is decreased level of consciousness and headache 1,2
Case in collaboration with my supervisors Dr. Joao Guilherme Boaretto Guimaraes and Dr. Gabriel Salvador.
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