A Case of Basal Ganglia Intraparenchymal Hemorrhage Following Lumbar Spinal Surgery

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 7; p. e65692
• Main Authors: Gigliotti, Michael J, Patel, Neel, Fritch, Chanju, Church, Ephraim W, Reiter, George T, Park, Hajoe
• Format: Journal Article
• Language: English
• Published: Palo Alto Cureus Inc 29.07.2024; Cureus
• Subjects: Anesthesia; Anticoagulants; Back surgery; Blood pressure; Case reports; Cerebrospinal fluid; Edema; Etiology; Females; Hematoma; Hemorrhage; Hershey, Milton Snavely; Hypertension; Hypotension; Mortality; Neurosurgery; Ostomy; Patients; Postoperative period; Tracheotomy; United States > US
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.65692

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.