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CASE OF THE MONTH

JUNE 2023

Submitted by Amy Chen MD FRCPC and Aditya Bharatha MD FRCPC, Division of Neuroradiology, St. Michael’s Hospital, Unity Health, University of Toronto.

~50F ruptured A-Comm aneurysm, reassess ventricular volume in ICU post bedside EVD insertion.

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CT and MRI from 1 day prior

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0.064T Hyperfine Swoop portable MRI following right frontal EVD insertion at bedside 

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DIAGNOSIS

pMRI Findings:

  • Air distension of right temporal horn, stable ventricular volume.

  • Unexpected new intraaxial signal abnormality in the right cerebellar hemisphere. Mixed T2 signal lesion with surrounding edema and local mass effect. In keeping with hemorrhage.

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Diagnosis: “Remote Cerebellar Hemorrhage”

  • Rare complication of supratentorial craniotomy, spinal surgery, CSF drain insertion

  • Pathophysiology: unknown, ? change in CSF volume/pressure causing cerebellar sagging, venous congestion and hemorrhagic infarction.

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CT follow up confirming cerebellar hemorrhage

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