Multiple supra- and infratentorial intraparenchymal hemorrhages presenting with seizure after massive sacral cerebrospinal fluid drainage.

STUDY

DESIGN

Case report and review of the literature.

OBJECTIVE

To describe a case of multiple supra- and infratentorial hemorrhages after spinal surgery presenting with seizure.

SUMMARY OF BACKGROUND DATA: Cerebrospinal fluid overdrainage is a well-documented factor associated with remote cerebellar hemorrhage, but supratentorial hemorrhages after spinal surgery have been reported rarely.

METHODS

A 64-year-old woman underwent a sacral laminectomy for recurrent chordoma. A negative pressure wound drain was left in after surgery and drained 1300 mL in the first 48 hours. On the fourth postoperative day, the patient presented with tonic-clonic seizures.

RESULTS

Diagnostic imaging showed multiple supra- and infratentorial intraparenchymal hemorrhages and a massive sacral cerebrospinal fluid leak. The patient underwent emergent surgery for a primary repair of the presumed dural defect.

CONCLUSION

Patients who present with severe positional headache, altered mental status, or tonic-clonic seizures after undergoing intradural spinal procedures involving massive cerebrospinal fluid loss may be suffering from multiple supra- and infratentorial intracranial hemorrhages.