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Cerebellar hemorrhage

Case contributed by Frank Gaillard

Presentation

6 hours of headache and disequilibrium.

Patient Data

Age: 65 years
Gender: Male

CT brain

ct

There is an acute parenchymal hemorrhage in the left cerebellar hemisphere, measuring 34 x 33 mm axially and surrounded by mild edema. 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 hemorrhage is identified.  Grey-white matter differentiation is preserved elsewhere.  Mild periventricular, subcortical and deep white matter hypodensity is consistent with chronic small vessel ischemia.

Case Discussion

This case illustrates typical appearances of a cerebellar hemisphere hemorrhage, 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. 

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