• Eberval Gadelha Figueiredo, Robson Luis Oliveira de Amorim, and Manoel Jacobsen Teixeira.
• Division of Neurological Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
• Neurol. Med. Chir. (Tokyo). 2009 Jun 1;49(6):229-33; discussion 233-4.

AbstractHemorrhage 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.

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