Koci, "Cerebellar herniation
and infarction as a complication of an occult postoperative lumbar dural defect," American Journal of Neuroradiology, vol.
With SBM, what one sees on the back is the tip of the iceberg as these patients invariably have a Chiari II malformation (often incorrectly referred to as the Arnold-Chiari malformation), typical features of which are cerebellar herniation
through the foramen magnum and brainstem distortion (Fig.
Computed tomography scan of the brain showed obstructive hydrocephalus and cerebellar herniation
. The patient died 1 day later.
This in turn can cause cerebellar herniation
, moreover if left unrecognized and untreated it subsequently leads to mortality.
1-4 show the tumor causing a pressure effect on the brain, herniation of the cerebellar tonsils 12 mm below the posterior margin of the foramen magnum and a mass effect on the brain stem with impending cerebellar herniation and brain stem compression.
* Lumbar puncture for suspicion of meningitis without performing a CT scan can lead to catastrophic cerebellar herniation if signs of increased ICP are missed .
Of major significance is Chiari malformation in its various subtypes and the possibility of cerebellar herniation in the event of raised intracranial pressure (ICP) or dural puncture.
Theoretically, the insertion of epidural block could have exposed her to a higher risk of dural puncture, PDPH, spinal cord trauma by the needle, or even the more grave complication of cerebellar herniation if a Chiari malformation was present.