Presentation
Headache. Unwell for several days with vomiting. Off legs for the last 24 hours. No trauma. Concern for intracranial mass lesion.
Patient Data
Prospectively, with the history given, this CT was called normal. Retrospectively, the area of hypodensity in the right cerebellar hemisphere is evident.
Abnormality centered on the superior surface of the right cerebellar hemisphere in the region of the right superior peduncle extending to the brainstem. T2 hyper intense, T1 hypointense, diffusion restriction and no enhancement. Features here are of ischemia/infarction.
Case Discussion
Pediatric stroke is not uncommon and needs to be considered to get the imaging correct. The initial CT would be very easy to call normal, especially if the clinical history didn't suggest a posterior circulation vascular abnormality.
MRI is far more sensitive and allows accurate depiction of the area of infarction as well as assessment of the vascular supply.
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