Remote cerebellar hemorrhage following surgical clipping of an unruptured cerebral aneurysm of the middle cerebral artery

An infrequent complication, remote cerebellar hemorrhage (RCH) may occur after supratentorial craniotomy at a reported incidence of 0.08-0.6%. Although RCH is mostly self limiting, early diagnosis and treatment are necessary as the condition may result in severe neurologic deficits or mortality. Because RCH is often asymptomatic, occurrence of it was occasionally recognized with brain computed tomography (CT) scans only. We experienced two contrasting cases of RCH in patients with unruptured cerebral aneurysms of the middle cerebral artery. These cases indicate that it should be mandatory to perform a brain CT scans immediately after surgery and on appropriate time to detect RCH. Awareness of this complication and close monitoring are essential for avoiding fatal neurological deficits or mortality.