{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T14:26:57Z","timestamp":1777300017381,"version":"3.51.4"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,6]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 Supratentorial subdural hematoma is a well-known complication following spinal interventions. Less often, spinal or supratentorial interventions cause remote cerebellar hemorrhage (RCH). The exact pathomechanism accounting for RCH remains unclear, but an interventional or postinterventional loss of cerebrospinal fluid (CSF) seems to be involved in almost all cases. Hemorrhage is often characterized by a typical, streaky bleeding pattern due to blood spreading in the cerebellar sulci. Three different cases featuring this bleeding pattern following spinal, supratentorial, and thoracic surgery are presented. Possible pathomechanisms leading to RCH are discussed. Based on data from the underlying cases and the reviewed literature, the authors concluded that this zebra-pattern hemorrhage seems to be typical in a postoperative loss of CSF, which should always be considered on presentation of this bleeding pattern.<\/jats:p>","DOI":"10.3171\/jns.2005.102.6.1159","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T18:04:03Z","timestamp":1242237843000},"page":"1159-1162","source":"Crossref","is-referenced-by-count":79,"title":["Zebra sign: cerebellar bleeding pattern characteristic of cerebrospinal fluid loss"],"prefix":"10.3171","volume":"102","author":[{"given":"Marc A.","family":"Brockmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Nowak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich","family":"Reusche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Russlies","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Br Med J","first-page":"3","article-title":"Editorial: lumbar puncture.","volume":"1","year":"1975"},{"key":"b2","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"256","DOI":"10.3171\/jns.1980.52.2.0256","article-title":"Intracranial subdural hematoma following lumbar myelography. Case report.","volume":"52","author":"Alemohammad","year":"1980"},{"key":"b3","series-title":"AJNR","first-page":"1312","article-title":"Cerebellar herniation and infarction as a complication of an occult postoperative lumbar dural defect.","volume":"16","author":"Andrews","year":"1995"},{"key":"b4","series-title":"Anesthesiology","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1097\/00000542-198403000-00026","article-title":"Intracerebral hemorrhage after dural puncture and epidural blood patch: nonpostural and noncontinuous headache.","volume":"60","author":"Benzon","year":"1984"},{"key":"b5","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1136\/jnnp.74.7.992","article-title":"Brain stem and cerebellar dysfunction after lumbar spinal fluid drainage: case report.","volume":"74","author":"Bloch","year":"2003"},{"key":"b6","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1097\/00006123-199612000-00009","article-title":"Intracerebral hemorrhage occurring remote from the craniotomy site.","volume":"39","author":"Brisman","year":"1996"},{"key":"b7","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"595","DOI":"10.3109\/02688699209002379","article-title":"Death from chronic tonsillar herniation in a patient with lumboperitoneal shunt and Crouzon's disease.","volume":"6","author":"Chumas","year":"1992"},{"key":"b8","series-title":"AJNR","first-page":"1573","article-title":"Posterior fossa hemorrhage after supratentorial surgery.","volume":"18","author":"Cloft","year":"1997"},{"key":"b9","series-title":"Med J Aust","doi-asserted-by":"publisher","first-page":"289","DOI":"10.5694\/j.1326-5377.1984.tb104042.x","article-title":"Intracranial subdural haematoma after metrizamide myelography.","volume":"140","author":"Dan","year":"1984"},{"key":"b10","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1136\/jnnp.74.6.752","article-title":"Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension.","volume":"74","author":"de Noronha","year":"2003"},{"key":"b11","series-title":"Neurosurgery","first-page":"1361","article-title":"Cerebellar hemorrhage after spinal surgery: report of two cases and literature review.","volume":"50","author":"Friedman","year":"2002"},{"key":"b12","series-title":"J Neurosurg Spine","first-page":"279","article-title":"Remote hemorrhage.","volume":"95","author":"Friedman","year":"2001"},{"key":"b13","series-title":"J Bone Joint Surg (Br)","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1302\/0301-620X.82B7.0821042","article-title":"Subacute subdural haematoma complicating lumbar microdiscectomy.","volume":"82","author":"Gehri","year":"2000"},{"key":"b14","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1007\/s101430000144","article-title":"Cerebellar haemorrhage after supratentorial aneurysm surgery with lumbar drainage.","volume":"24","author":"Gelfenbeyn","year":"2001"},{"key":"b15","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1001\/jama.1972.03190280041009","article-title":"Headache following subarachnoid puncture. Treatment with epidural blood patch.","volume":"219","author":"Glass","year":"1972"},{"key":"b16","series-title":"Br Med J","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1136\/bmj.296.6614.51","article-title":"Development of neurological problems after lumbar puncture.","volume":"296","author":"Hart","year":"1988"},{"key":"b17","series-title":"ROFO","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1055\/s-2008-1056508","article-title":"Akutes subdurales hematom nach lumbaler myelographie.","volume":"135","author":"Heiss","year":"1981"},{"key":"b18","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"332","DOI":"10.3171\/spi.2004.100.4.0332","article-title":"Subarachnoid-pleural fistula after resection of thoracic tumors.","volume":"100","author":"Hentschel","year":"2004"},{"key":"b19","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3171\/jns.2002.96.2.0248","article-title":"Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery: a retrospective study.","volume":"96","author":"Honegger","year":"2002"},{"key":"b20","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1007\/BF00394735","article-title":"Epidural placement of Pantopaque after myelography.","volume":"5","author":"Jensen","year":"1973"},{"key":"b21","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1080\/02688699943790","article-title":"Cerebellar haemorrhage after evacuation of an acute supratentorial subdural haematoma.","volume":"13","author":"Kaplan","year":"1999"},{"key":"b22","series-title":"Acta Neurochir","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s007010050347","article-title":"Posterior-fossa haemorrhage after supratentorial surgery\u2014report of three cases and review of the literature.","volume":"141","author":"Koller","year":"1999"},{"key":"b23","series-title":"Acta Neurochir","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1007\/BF01404145","article-title":"Cerebellar haemorrhage as a complication after supratentorial craniotomy.","volume":"88","author":"Konig","year":"1987"},{"key":"b24","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1001\/jama.1974.03230440042030","article-title":"Chronic postmyelographic headache. A result of persistent epidural cerebrospinal fluid fistula.","volume":"229","author":"Levine","year":"1974"},{"key":"b25","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1001\/archneur.1960.03840070064007","article-title":"Pontine hemorrhage following cranial surgery for supratentorial tumor.","volume":"2","author":"Madow","year":"1960"},{"key":"b26","series-title":"Dtsch Med Wochenschr","first-page":"1820","article-title":"Kraniales subdural hematom nach Myelographie.","volume":"111","author":"Megele","year":"1986"},{"key":"b27","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1227\/00006123-198206010-00002","article-title":"Intracerebral hematoma after evacuation of chronic extracerebral fluid collections.","volume":"10","author":"Modesti","year":"1982"},{"key":"b28","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"150","DOI":"10.3171\/spi.2001.94.1.0150","article-title":"Intracerebral hemorrhage complicating cervical \u201chourglass\u201d schwannoma removal. Case report.","volume":"94","author":"Morandi","year":"2001"},{"key":"b29","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1097\/00006123-199610000-00040","article-title":"Contralateral cerebellar hemorrhagic infarction after pterional craniotomy: report of five cases and review of the literature.","volume":"39","author":"Papanastassiou","year":"1996"},{"key":"b30","series-title":"J Neuropathol Exp Neurol","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1097\/00005072-195207000-00004","article-title":"Brain stem hemorrhages secondary to supratentorial space-taking lesions.","volume":"11","author":"Poppen","year":"1952"},{"key":"b31","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s002340050049","article-title":"Intracranial haemorrhage following lumbar myelography: case report and review of the literature.","volume":"42","author":"Suess","year":"2000"},{"key":"b32","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"718","DOI":"10.3171\/jns.1996.85.4.0718","article-title":"Cerebellar hemorrhage complicating temporal lobectomy. Report of four cases.","volume":"85","author":"Toczek","year":"1996"},{"key":"b33","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/0090-3019(93)90147-S","article-title":"Cerebellar hemorrhage complicating supratentorial craniotomy: report of two cases.","volume":"40","author":"van Calenbergh","year":"1993"},{"key":"b34","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1227\/00006123-198312000-00008","article-title":"Intracerebral hemorrhage remote from the site of the initial neurosurgical procedure.","volume":"13","author":"Waga","year":"1983"},{"key":"b35","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1227\/00006123-197707000-00005","article-title":"Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia.","volume":"1","author":"Ya\u015fargil","year":"1977"},{"key":"b36","series-title":"Neurol Med Chir","doi-asserted-by":"publisher","first-page":"738","DOI":"10.2176\/nmc.30.738","article-title":"Cerebellar hemorrhage after supratentorial craniotomy\u2014report of three cases.","volume":"30","author":"Yoshida","year":"1990"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/102\/6\/article-p1159.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/102\/6\/article-p1159.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/102\/6\/article-p1159.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,3]],"date-time":"2022-07-03T14:51:01Z","timestamp":1656859861000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/102\/6\/article-p1159.xml"}},"subtitle":["Case report"],"short-title":[],"issued":{"date-parts":[[2005,6]]},"references-count":36,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/jns.2005.102.6.1159","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2005,6]]}}}