Signs of raised intracranial pressure. A CT scan was performed showing obstructive hydrocephalus. A VP shunt was inserted.
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The MRI sequences demonstrate a midline cystic mass of the posterior cerebral fossa of vermian location with two components: a cystic component of low signal intensity on T1WI, and FLAIR, and high signal intensity on T2WI with no peripheral enhancement, and a solid-cystic component as a mural nodule of posterior location with heterogeneous enhancement on postcontrast sequences. No restricted diffusion on DWI/ADC. Mild perilesional edema in noted as well as a mass effect on the adjacent structures (cerebellar hemispheres, brainstem, midbrain, and 4th ventricle) with tonsillar herniation. The VP shunt is seen in the projection of the right occipital horn.
No other lesions are seen to suggest a von Hippel Lindau syndrome.
The patient went on to have a resection and the histopathological study confirmed the diagnosis of a hemangioblastoma.