34-year-old male with intracranial hemorrhage. Evaluate for interval change in the hematoma. History of hemangioblastoma resection from posterior fossa and status post EVD placement.EMR: 12/14: POD1 s/p posterior fossa craniotomy for recurrent hemangioblastoma resection complicated by intraoperative hemorrhage. There is extensive heterogeneous evolving intracranial hemorrhage involving the now large resection cavity in the fourth ventricle with severe crowding of the posterior fossa, near complete effacement of the fourth ventricle and other CSF spaces, including compression/anterior displacement of the the brainstem. There is interval development of new FLAIR hyperintensity involving the right brachium pontis. There is a thin rim of restricted diffusion and FLAIR hyperintensity along the margins of the resection cavity, especially on the right and extending into the superior vermis which may be in part from post-operative ischemia, and possibly also from compressive ischemia from the swelling. This was likely present on the most recent prior head CT exam but is better delineated by today's MRI.There is prominent intraventricular hemorrhage with slightly higher level of dependent hemorrhage in the occipital horn of the left lateral ventricle but this may be due to redistribution, especially since the size of the ventricles have improved. The right frontal approach ventriculostomy tube is unchanged in position. There is a tiny amount of air and/or blood product around the catheter. A second tract is seen in the brain right frontal parenchyma next to the catheter. There is a small air fluid level in the left maxillary sinus and fluid in the nasal cavity and oropharynx, which may be secondary to intubation status.
1.Evolving hemorrhage within the posterior fossa resection cavity with post-operative ischemic changes involving the cerebellum, including extending into the vermis. Resultant significant crowding of the posterior fossa structures, with now fourth ventricular near complete effacement and compression on/anterior displacement of the the brainstem. 2.Stable likely redistributed intraventricular hemorrhage and Interval improvement in the size of the lateral ventricles.