Superatentorial intracerebral hemorrhage following infratentorial surgery.

Supratentorial hematoma following infratentorial surgery is rare. We present two such patients with remote site supratentorial hematoma after posterior fossa surgery. In one patient, a supratentorial hematoma developed following surgery for an acoustic tumor. The supratentorial hematoma was located near where a supratentorial meningioma was excised five days before. No hematoma was seen on the immediate postoperative CT scan. In another patient there were two tumors, one in the pons and the other in the basal ganglia. This patient developed a basal ganglia hematoma following brain stem surgery. In both the patients, hematological profile revealed a coagulation abnormality following the posterior fossa surgery. Our first case stabilized conservative management, whereas the second required surgical evacuation of the hematoma. The differential diagnosis of declining level of consciousness after posterior fossa surgery must include supratentorial intracerebral hemorrhage and CT scan of the head is the diagnostic test of choice.