Disproportionate atrophy of the left cerebellar hemisphere with concordant asymmetry of the bony posterior fossa suggesting this is a congenital/long-term process. There are no features to indicate cerebellar dysplasia, with the cerebellar folia and the grey-white matter differentiation preserved. There is a left cerebellar developmental venous anomaly (best appreciated on susceptibility weighted sequences) draining anteriorly to veins in the left cerebellopontine angle. This is associated with multiple linear and nodular foci of susceptibility related signal loss, corresponding to foci of calcification demonstrated on recent CT. No T2 or FLAIR signal abnormality in the adjacent brain parenchyma. No evidence of recent haemorrhage.
Appearance and intensity of brain parenchyma are otherwise normal. Ventricular system and cisternal spaces appear normal. MRA time-of-flight is unremarkable, with no other vascular malformations identified.