Clinical question: Evaluate for hydrocephalus. Signs and symptoms: Gait instability. Non-enhanced CT of brain:Examination demonstrate a highly suspected loculated mass in the left cerebellum with extensive surrounding vasogenic edema. There is significant mass-effect on the fourth ventricle with near complete collapse of the ventricle. There is crowding of the cerebellar tonsils at the level of foramina magnum and effacement of prepontine and cerebellopontine angle cisterns as well as effacement and deformity of the quadrigeminal plate. Consistent with significant mass effect in the posterior fossa and upward transtentorial herniation.Images through supratentorial space demonstrates significant enlargement of the supratentorial ventricular system consistent with hydrocephalus. There are a few small foci of periventricular and subcortical low attenuation that although may represent small vessel disease considering patient's tumor but in the posterior fossa these areas of low attenuation may represent edema and metastatic lesions. A dedicated MRI with enhancement is recommended. There is no evidence of hemorrhage or midline shift.
1.Mass with extensive surrounding vasogenic edema in the left cerebellum with significant associated mass effect and upward transtentorial herniation.2.Supratentorial hydrocephalus.3.Dedicated MRI examination with enhancement is recommended.4.The above findings were relayed to Dr.Thomas Kelley from neurosurgery department at the time of interpretation.