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.
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~50F ruptured A-Comm aneurysm, reassess ventricular volume in ICU post bedside EVD insertion.
CT and MRI from 1 day prior
0.064T Hyperfine Swoop portable MRI following right frontal EVD insertion at bedside
DIAGNOSIS
pMRI Findings:
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Air distension of right temporal horn, stable ventricular volume.
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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.
Diagnosis: “Remote Cerebellar Hemorrhage”
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Rare complication of supratentorial craniotomy, spinal surgery, CSF drain insertion
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Pathophysiology: unknown, ? change in CSF volume/pressure causing cerebellar sagging, venous congestion and hemorrhagic infarction.
CT follow up confirming cerebellar hemorrhage