A ventriculoperitoneal shunt was inserted and an MRI exam was performed a few days later.
The previously described right cerebellar lesion shows a low signal intensity on T1WI, intermediate signal intensity on T2WI and FLAIR, and heterogeneous enhancement following IV contrast with central necrosis. On DWI it appears of high signal with low ADC (restricted diffusion). Peripheral vasogenic oedema with mass effect on the 4th ventricle and brainstem are noted. The adjacent right lateral and straight venous sinuses are patent. The multivoxel MR spectroscopy reveals a dominant peak in Lipids / Lactate (LL), elevated choline peak as well as choline/creatine ratio, and decreased creatine and NAA peak at the solid component of a tumour. The MR spectroscopy at vasogenic oedema around the lesion (not shown) demonstrated a pattern of depressed metabolites.