Ictal headache and neck pain, progressive confusion quickly resulting in comatose state.
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- There is a circumsribed hemorrhagic focus in the medial part of the right cerebellar lobe (evaluation of the posterior cranial fossa is somewhat more challenging due to metal artifacts caused by dental implants).
- The hemorrhage expanded into the third and fourth ventricle, as well as the dorsal horns of the lateral ventricles.
- Consequent moderate hydrocephalus is most easily noted by looking at the lateral ventricles. Cerebellar tonsillar herniation has not yet developed.
- Marked periventricular and deep white matter hypointensities indicate advanced small vessel ischemia.
Typical presentation of cerebellar hemorrhage that expanded into the ventricular system, further worsening the prognosis.