Intracerebral hemorrhage secondary to vaccine-induced thrombotic thrombocytopenia

Midline cerebellar hematoma with minimal perihaematomal edema. There is effacement of the fourth ventricle with lateral and third ventricular hydrocephalus. No transtentorial or tonsillar herniation.

There is hyperattenuation of the internal cerebral veins, vein of Galen, straight sinus, right transverse and sigmoid sinus, and included right internal jugular vein.

No definite subarachnoid, subdural or intraventricular hemorrhage. 

The thalami are difficult to delineate clearly.

There is extensive thrombosis involving the internal cerebral veins, inferior sagittal sinus, vein of Galen, straight sinus, right transverse and sigmoid sinus, right jugular bulb and the immediate extracranial right jugular vein. Small filling defect in the proximal left transverse sinus in keeping with non occlusive thrombus.

Right frontal approach ventricular drain with reduction in the degree of hydrocephalus.

Midline cerebellar hematoma with increased perihaematomal edema, and causing mass effect on the fourth ventricle and crowding at the foramen magnum.

Abnormal T1, T2 and FLAIR signal in the right transverse sinus, sigmoid sinus and jugular bulb corresponding to the known thrombus.

Multifocal high FLAIR signal within the cortical sulci is compatible with subarachnoid blood.

Swelling of the left thalamus with abnormal T2 signal and mild restriction diffusion, in keeping with a venous infarct. There is a small focus of high T1 signal superiorly in the left thalamus consistent with a small hemorrhagic component. More pronounced foci of susceptibility artefact in the thalami bilaterally and right caudate head are also in keeping with blood products.

Small area of abnormal diffusion restriction within the splenium, which would be consistent with a cytotoxic lesion of the corpus callosum (CLOCC).