A Case of Basal Ganglia Intraparenchymal Hemorrhage Following Lumbar Spinal Surgery

TL;DR

A rare case of brain hemorrhage after spinal surgery is reported, highlighting unusual complications from cerebrospinal fluid leaks.

Contribution

This paper presents a novel clinical case linking spinal surgery complications to rare intracranial hemorrhage.

Findings

A 65-year-old patient developed basal ganglia hemorrhage after lumbar spinal surgery with CSF leak.

The patient required decompressive surgery and had a poor functional outcome despite interventions.

Abstract

We report on a rare case of basal ganglia intraparenchymal hemorrhage with intraventricular extension occurring after a lumbar spinal surgery. A 65-year-old female presented for an elective L4-L5 lumbar laminectomy and posterior spinal fixation. Her initial operation was complicated by a cerebrospinal fluid (CSF) leak repaired with a dural synthetic graft. Her immediate post-operative course was complicated by delayed emergence, eye-opening apraxia, and left-sided hemiplegia and subsequent computed tomography (CT) of the head demonstrated a right-sided basal ganglia intraparenchymal hemorrhage (IPH) with intraventricular extension. CT angiogram of the head was unremarkable. She was taken back to the operating room for right-sided decompressive hemicraniectomy and external ventricular drainage (EVD) for hydrocephalus. Her EVD was discontinued on post-bleed day 13 and she was discharged on post-bleed day 14 to a long-term care facility with a modified Rankin scale (mRS) score of 6. She returned for a cranioplasty six months later, and on her last follow-up at nine months, had a mRS of 4 with persistent confusion and severe left-sided hemiparesis but was able to form simple sentences. In summary, intracranial hemorrhage is a rare complication of spine surgery, occurring in a small percentage of the population. Lobar IPH following spinal surgery is a rare complication, and has been hypothesized to be a result of excessive CSF loss during durotomy.

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