Remote intracranial hemorrhage after supratentorial and spinal surgery: a three case series and review of literature

Abstract Background Remote intracranial hemorrhage (RIH) is a rare postoperative complication following neurosurgical procedures. It may occur in the supratentorial, cerebellar, epidural, or subdural compartments and is often associated with cerebrospinal fluid (CSF) leakage. Objective The objective of this study was to present a case series of RIH, emphasizing the role of magnetic resonance imaging (MRI) in early detection and discussing potential pathophysiological mechanisms. Methods Three patients with postoperative RIH were evaluated using MRI and computed tomography (CT). Imaging was reviewed by two radiologists with 8–15 years of experience. Results Each case demonstrated unique postoperative RIH presentations, confirmed by imaging. Detailed MRI protocols included T1-weighted, T2-weighted, FLAIR, gradient echo (GRE)/susceptibility-weighted imaging (SWI), and contrast-enhanced sequences at 1.5 T with 3–5 mm slice thickness. Conclusion Early MRI is critical for detecting RIH, particularly in patients with postoperative CSF leakage, to enable prompt management and improved outcomes.