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CB1034

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Case Notes

History

11 yo female w/ Langerhans histiocytosis mass resected 6 yrs earlier. No has 2 week history of dizziness, gait instability and headaches. Cerebellar biopsy: nonspecific inflammation (SIRS)

Exam

Prior Study

Noncontrast head CT and T2- MR obtained 5 days after the CT
1. Unexplained cerebellar tonsillar displacement in the context of apparent bilateral cerebellar edema.
2. T2-w MR obtained 5 days after the head CT exhibits both the earliest features of obstructive hydrocephalus related to parenchymal cerebellar edema and caudal 4th ventricle outlet obstruction.

Sagittal post contrast MR
1. Nonspecific, cerebellar edema producing early downward tonsillar herniation
2. Evidence of early enlargement of the lower (hypothalamic segment) of the 3rd ventricle consistent with the earlies evidence of obstructive hydrocephalus, as above.

Dicom

 
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Submit Findings

CB1034

Findings

MR Flair

There is evidence of increased CSF pressure with subependymal edema, and possibly other primary features of hydrocephalus (tight ependymal margins, expanded lower segment 3rd ventricular walls).

There are additional (secondary) imaging features of  elevated CSF pressure with hyperdynamic CSF pulsations, optic hydrops and papilledema.

There is evidence of active leptomeningitis with subpial edema.

There is evidence of active leptomeningitis or pachymeningitis related to para-cranial infection (coalescent otomastoiditis, central skull base infection, aggressive nasopharyngeal infection or paranasal sinusitis.

There is evidence of CSF hyperintensity consistent with subarachnoid or intraventricular acute or subacute blood products.

There is cortical/subcortical edema consistent with cortical venous thrombosis.

There is parenchymal edema consistent with arterial thrombosis.

There is subcortical and central watershed edema consistent with vasospasm and hypoperfusion.

NO other significant imaging findings are present.