Presentation
Autistic patient with acute cerebellar manifestation.
Patient Data
Abnormal swelling and diffuse T2 high signal of the left cerebellar hemisphere cause significant compression on the brain stem and effaced 4th ventricle. Resultant supratentorial hydrocephalic changes with periventricular permeation are also noted. DWI shows almost free diffusion, with multiple areas of restricted diffusion corresponding to ring-enhancing lesions on post-contrast T1. The post-contrast series shows multiple ring-enhancing areas as well as meningeal enhancement. Significant signal changes associated with diffusion restriction are seen in the left mastoid cells. Normal enhancement of the venous sinuses with a filling defect within the proximal left IJV suggests a possible thrombus.
Case Discussion
MRI findings are consistent with a left cerebellar abscess secondary to left acute mastoiditis with a possible internal jugular vein thrombus.