Presentation
Previous history of operation. Presently complains of headache and vertigo.
Patient Data
Present study reveals altered signal intensity lesion measuring approx.
37 x 45 x 48 mm (AP X TD X CC) in posterior fossa, filling, distending fourth ventricle. Vermis is not well visualized separately. Lesion is splaying, possibly infiltrating brainstem anteriorly, splaying bilateral middle cerebellar peduncles, cerebellar hemispheres and extending into left foramina of Luschka.
Lesion shows diffusion restriction, areas of central necrosis, foci of hemorrhage and heterogeneous enhancement on post contrast study.
Prominent cystic component is seen at posterior aspect of the lesion.
Multiple microhemorrhages are seen in bilateral cerebral parenchyma.
Mineralization of bilateral globi palladi is seen.
Case Discussion
Patient is a follow up operated case of medulloblastoma with evidence of post operative changes, right suboccipital craniotomy and VP shunt in situ. Gliotic areas are seen in right frontal lobe, anterior body of corpus callosum and in left frontal periventricular white matter, likely related to prior VP shunt tract.
Above findings are suggestive of a recurrent lesion and are characteristic of a medulloblastoma.
Multiple microhemorrhages in bilateral cerebral parenchyma are likely radiation induced.
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