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Background Remote cerebellar haemorrhage (RCH) remains an uncommon complication of both intracranial and spinal surgery. In the latter, RCH was more frequently reported as a complication of spinal decompressive procedures. Whilst the exact pathophysiology remains unclear, an acute intracranial hypotension due to excessive perioperative cerebrospinal fluid (CSF) loss may be partly responsible.Methods and result We describe the potential implication(s) and pathophysiology of a bilateral RCH in an 80-year-old male following lumbar laminectomy. The following day he developed a new headache and was found to be dysarthric with bilateral upper limb ataxia. An urgent computed-tomography brain imaging demonstrated bilateral superior cerebellar haemorrhage. Magnetic resonance imaging of his lumbar spine demonstrated dissecting spinal sub-dural extra-arachnoid CSF hygroma. The acute management included nursing patient in intensive care unit, at -10° head down with strict bed rest for at least subsequent 48 hours in conjunction with judicial hypertension management. Improvement to his cerebellar dysarthria and ataxia was evident a week after the spinal surgery.Conclusion RCH remains uncommon but early recognition of a deterioration in neurological status saves lives and reduces morbidity. Our case presented a mechanism of CSF loss via formation of CSF hygroma in the sub-dural extra-arachnoid space, likely contributing to the acute intracranial hypotension as a potential mechanism for RCH. Symptoms described here should prompt clinicians to this phenomenon coupled with urgent brain imaging, thus allowing for early intervention.