INTRODUCTION: Remote cerebellar haemorrhage (RCH) is an uncommon, infratentorial complication with a reported incidence ranging from 0.04% to 0.8%. This condition can develop after various neurosurgical procedures, mostly following supratentorial craniotomies. Typically identified on computed tomography (CT) by the characteristic “zebra sign.” Owing to nonspecific clinical presentation RCH remains an underdiagnosed postoperative complication and should be considered in the differential diagnosis of neurological deterioration after cranial surgery.

AIM(S): To illustrate a rare but clinically significant complication of supratentorial aneurysm surgery and emphasize its diagnostic implications.

METHOD(S): A single-patient case analysis was performed. A 65-year-old male undergoing elective supratentorial aneurysm clipping was assessed postoperatively using serial neurological examinations and computed tomography imaging. The diagnosis of RCH was established based on the characteristic distribution of infratentorial bleeding and temporal relationship to surgery.

RESULTS: Conservative management was pursued. Serial imaging demonstrated radiological stabilization with gradual regression of haemorrhagic lesions despite transient cerebrospinal fluid leakage. Recurrent seizures complicated the clinical course. The patient was discharged after prolonged hospitalization with residual left lower limb paresis and cerebellar syndrome.

CONCLUSIONS: The pathophysiology of RCH remains incompletely understood. Current evidence suggests that abrupt alterations in intracranial pressure, cerebrospinal fluid loss, arterial hypertension, perioperative seizures play a pivotal role. This case underscores the importance of recognizing RCH as a potential postoperative complication and demonstrates that, despite significant morbidity, conservative management may result in a favorable neurological outcome.

FINANCIAL SUPPORT: None.