- 60yo M with
- hx vertigo
- presented to OSH for
- dizziness, vomiting, and left facial droop.
- CT/CTA showed L vertebral artery narrowing and
- large L cerebellar infarct with
- mass effect on 4th ventricle and hydrocephalus.
- Progressive somnolence
- requiring intubation and
- given hyperosmolar therapy.
- Underwent s/p decompressive suboccipital craniectomy and R frontal EVD placement
- Course complicated by
- vasogenic edema,
- LLE DVT (IVC filter placed ),
- ventilatory/oxygenation issues,
- CT
- Large posterior circulation infarction with
- marked mass effect within the posterior fossa and
- crowding of the basal cisterns and foramen magnum.
- Linear areas of hyperdensity within the left posterior fossa
- likely consistent with hemorrhagic conversion.
- Dilatation of the third and lateral ventricle secondary to obstructive hydrocephalus.
001 60 head CT
Ashley Davidoff TheCommonVein.net
001b 60 head CT
Ashley Davidoff TheCommonVein.net
002 60 head CXR
Ashley Davidoff TheCommonVein.net
- MRI
- Postprocedural changes from a since removed right frontal approach EVD catheter
- There remains a small amount of blood products within the bilateral posterior horns and fourth ventricle.
- Numerous areas of SWI artifact within the left cerebellum consistent with residual blood products from known left cerebellar hemorrhage.
- There remains effacement of the left ambient cistern from the left cerebellar edema.
- The ventricles are overall similar to minimally increased in size
-
Hemorrhagic cerebellar infarct non cardiogenic pulmonary edema 003a 60 MRI SWI
Ashley Davidoff TheCommonVein.netHemorrhagic cerebellar infarct non cardiogenic pulmonary edema 003b 60 MRI SWI
Ashley Davidoff TheCommonVein.netHemorrhagic cerebellar infarct non cardiogenic pulmonary edema 003c 60 MRI SWI
Ashley Davidoff TheCommonVein.netFollow Up CXR 2 weeks later
Ashley Davidoff TheCommonVein.net