Remote cerebellar hemorrhage following repeated lumbar punctures

BMC Neurology

Case Report

Dongsen Wang¹  Qingjian Wu²  Hai-Yang Wang³  Jinming Han⁴  Zerui Hu⁵ 

[1] Clinical Medical College of Jining Medical University, 272067, Jining, Shandong Province, China;Department of Emergency, Jining No.1 People’s Hospital, No. 6, Jiankang Road, 272011, Jining, Shandong Province, China;Department of Neurology, Jining No.1 People’s Hospital, 272000, Jining, Shandong Province, China;Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China;Department of Psychiatry, School of Mental Health, Jining Medical University, 272000, Jining, China;

关键词: Remote cerebellar hemorrhage;    Repeated lumbar punctures;    Meningoencephalitis;    Zebra sign;    MRI;   

DOI  :  10.1186/s12883-023-03276-6

 received in 2022-09-20, accepted in 2023-06-04,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundRemote cerebellar hemorrhage (RCH) is a rare complication in neurosurgery. No case of RCH secondary to repeated lumbar punctures (LPs) has been previously reported.Case presentationA 49-year-old man presented with impaired consciousness following persistent fever. Cerebrospinal fluid examination showed high opening pressure, elevated white blood cells, increased protein level, and decreased glucose level, resulting in a diagnosis of bacterial meningoencephalitis. Treatment with repeated LPs and intrathecal injection of ceftriaxone resulted in an improvement in neurological symptoms. However, on day 31 of treatment, brain magnetic resonance image (MRI) showed streaky bleeding in bilateral cerebellum (zebra sign), leading to a diagnosis of RCH. Close observation and repeated brain MRI imaging without specific treatments led to the absorption of bilateral cerebellar hemorrhage, and the patient was discharged with improved neurological symptoms. Repeated brain MRI scans one month after discharge showed that bilateral cerebellar hemorrhage had improved, and had disappeared one year after discharge.ConclusionWe reported a rare occurrence of LPs-induced RCH presenting as isolated bilateral inferior cerebellar hemorrhage. Clinicians should be vigilant of the risk factors for RCH, closely monitoring patients' clinical symptoms and neuroimaging findings to determine the need for specialized treatment. Furthermore, this case highlights the importance of ensuring the safety of LPs and managing any potential complications appropriately.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 4