Disclosures: Kathy Chou, DO: Nothing to disclose

Case Description: The patient with past medical history of anxiety and hypertension underwent elective lumbar laminectomy for resection of asymptomatic intradural schwannoma. Several days after surgery, she developed a headache followed by right-sided hearing loss, intermittent diplopia and left hemiplegia. Computed tomography and magnetic resonance imaging (MRI) head demonstrated right frontal and left parietal intraparenchymal hemorrhages, intraventricular and diffuse subarachnoid hemorrhages. MRI lumbar spine revealed a pseudomeningocele suggestive of cerebrospinal fluid (CSF) leak, and she subsequently underwent dural repair. Angiogram of the head/neck and repeat imaging were negative for arteriovenous malformations, aneurysms or mass. She was admitted to acute inpatient rehabilitation for left hemiplegia secondary to multifocal hemorrhagic strokes.

Setting: Acute Rehabilitation Hospital

Patient: 56-year-old Caucasian female with new neurologic deficits after lumbar spinal surgery.

Assessment/Results: On admission to acute rehabilitation, she had preserved strength on the right but no movement in left proximal arm and lower extremity. Two weeks into acute rehabilitation, she regained antigravity strength in distal left upper and lower extremities.

Discussion: Intracranial hemorrhages after spinal surgery are extremely rare and are attributed to incidental or purposeful durotomies with a CSF leak. It is suspected that the negative intracranial pressure that develops with CSF leaks applies tension on cerebral blood vessels, nerves and meninges. The most severe consequences have poor prognoses and include reversible coma, cerebral herniation and infarction. Only several intracranial hemorrhagic cases after spinal surgery have been reported and most were cerebellar or subdural hematomas. This is the first case, to our knowledge, of multifocal and intraparenchymal hemorrhages following spinal surgery.

Conclusion: Physiatrists need to be aware of the rare sequelae after spinal surgery. Neurologic findings following spinal surgery should prompt not only evaluation of surgical site, but also for dural tear and new intracranial pathology.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rare-multifocal-intraparenchymal-hemorrhages-following-spinal-surgery-a-case-report/