Presentation
Rapid onset of head ache, torticollis and papilloedma. Known Treacher Collins syndrome.
Patient Data
This demonstrates unilateral enlargement of the left cerebellar hemisphere, in particular the neocerebellum with evidence of hypointensity of the affected segment on T1 and hyperintensity on T2. The ipsilateral folia appear marginally enlarged with distortion of the fourth ventricle and deviation of the brainstem to the right. There is associated leptomeningeal enhancement. Both lateral, third, and temporal horns are dilated. No intraparenchymal abnormalities demonstrated.
There has been resolution of the previous abnormal T2 bright signal in the left cerebellar hemisphere. Residual T2 brightness seen peripherally does appear to be due to volume loss with increased extra-axial CSF. The deep left cerebellum, vermis and right cerebellar hemisphere show normal appearances.
The supratentorial structures are normal. The third and lateral ventricles have reduced in size from before in keeping with improvement of a degree of hydrocephalus that was present with the initial cerebellar abnormality.
Case Discussion
This case illustrates how important it is to take all imaging findings in the clinical context. This patient's cerebellitis has imaging appearances very similar to Lhermitte-Duclos disease.