Presentation
Headache.
Patient Data
Right parietal burr hole with a right parietal ventricular drain on suction. Tip of the catheter lies within the body of the left lateral ventricle.
New bilateral chronic subdural collections, with a thin layer of acute hemorrhage also noted on the right. The right subdural collection replaces the pneumocephalus on the previous study and now measures up to 9mm on coronal images. The left subdural measures up to 6mm on coronal images. Minor effacement of the underlying sulci.
No midline shift. No acute intracranial hemorrhage.
The left petroclival meningioma is again noted with stable mass-effect on the left anterolateral pons and fourth ventricle. No other intra or extra-axial mass or areas of abnormal enhancement. Ventricular size is marginally reduced with the maximum biventricular distance now measuring 3.6cm (previously 4.0cm). The temporal horns are no longer dilated.
Periventricular and deep white matter hypodensity is in keeping with chronic small vessel ischemia. Previous right cerebellar infarct.
Conclusion: Right acute on chronic and left chronic subdural collections. Left petroclival meningioma is stable.
Case Discussion
The appearances are characteristic of a clival meningioma. There is also a right acute on chronic subdural hematoma and a left chronic subdural hematoma.
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