Specific Imaging Findings

Remote cerebellar hemorrhage (RCH) typically occurs bilaterally along the superior aspect of the cerebellum following the cerebellar folia in a linear arched pattern that has been termed “zebra sign”. A recent RCH is seen as multiple linear hyperdensities on non-enhanced CT images. The same striped pattern is found on MRI, and it follows the signal intensity characteristics that vary according to the age of hemorrhage. The susceptibility effect from blood products is seen as signal loss on T2* MR sequences, gradient echo (GRE) or susceptibility-weighted images (SWI). Unilateral RCH is infrequent. Vascular studies, CTA, MRA, or DSA, reveal intact appearance of the venous sinuses and other vascular structures, without signs of thrombosis.

Pertinent Clinical Information

RCH is a rare complication of cranial and spinal surgeries that include opening of the dura. It has been reported following a wide range of procedures, from laminectomies and lumbar CSF drainages to temporal lobectomies, vascular neurosurgery, supratentorial tumor resections, and even single burr hole drainages. The most common symptoms are decreased level of consciousness, headache, nausea, and dizziness. The onset of symptoms is in the range from a few hours to a number of days after the surgical procedure. RCH is frequently benign and self-limited, but it may entail significant morbidity and result in death.