Cerebellar hemorrhage with herniation
Post cardiac ablation.
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There is a large right cerebellar lobe intraparenchymal hemorrhage associated with extension into the fourth ventricle. There is a degree of downward cerebellar tonsillar herniation and upward transtentorial herniation, effacement of the basal cisterns and compression of the brain stem. The temporal horns are distended. The cerebral sulci are not effaced.
In this setting, one should consider whether an underlying lesion is present. Given the recent cardiac intervention which almost certainly required intravenous heparinisation, it is likely that this is a primary hemorrhage.
The patient had the clot urgently evacuated. Followup and MRI (not shown) failed to demonstrate an underlying cause.