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What is the main differential diagnosis list?
Given the imaging appearance and age of the patient: cerebellar mets (such as lung, breast and melanoma) is the main differential. Also, although much less commonly in this age, medulloblastoma is in the list.
Large hyperdense posterior fossa mass, with significant positive mass effect on the brain stem and fourth ventricle resulting in lateral and third ventricular dilatation with periventricular low density, in keeping with transependymal spread of CSF.