Presentation
The patient has been in a coma for 2 days. Prior to that, they experienced headaches and dizziness.
Patient Data
The midbrain -including the tectum and superior cerebellar peduncles- is expanded by an enhancing lesion. The lesion returns low signals on T1WI, and high signals on T2/FLAIR with vivid enhancement post IV contrast. The lesion has relative diffusion restriction. No blooming artifact in T2*GRE to suggest hemorrhage/calcification.
The mass lesion is compressing the Sylvain aqueduct resulting in proximal tri-ventricular acute hydrocephalus (evident by trans-ependymal CSF leakage).
Case Discussion
Considering the location of the mass, the features are likely of tectal plate glioma. No pathology or follow-up is available.
The presence of trans-ependymal CSF leakage suggests the nature of the hydrocephalus is acute.