Presentation
Progressive headache of 4 years duration.
Patient Data
Multisequence MRI of the brain showed a heterogeneous lesion replacing the left cerebellar hemisphere and causing mass effect with resultant obstructive hydrocephalus. The lesion is hyperintense on the T2 weighted images and demonstrates the typical striated folial pattern, also described as the tigroid / tiger striped appearance. The hyperintense stripes suppress on FLAIR. It also has a striated appearance of the T1 weighted images with alternating hypo and isointense bands. No significant enhancement was noted except for vascular structures traversing the lesion. No evidence of diffusion restriction on the ADC images.
Case Discussion
The described imaging findings strongly suggest the diagnosis of dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease). The T2 hyperintense, striated folial pattern involving a single cerebellar hemisphere is classical for this condition.
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