6 hours of headache and disequilibrium.
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There is an acute parenchymal haemorrhage in the left cerebellar hemisphere, measuring 34 x 33 mm axially and surrounded by mild oedema. It is causing local mass effect, partially effacing the fourth ventricle, resulting in mild hydrocephalus (as evidenced by mild dilation of the temporal horn of the left lateral ventricle). There is no significant cerebellar tonsillar herniation, however.
No further intracranial haemorrhage is identified. Grey-white matter differentiation is preserved elsewhere. Mild periventricular, subcortical and deep white matter hypodensity is consistent with chronic small vessel ischaemia.
This case illustrates typical appearances of a cerebellar hemisphere haemorrhage, most frequently due to poorly controlled hypertension (as was the case in this instance). If no history of hypertension is present an underlying lesion should be sought.