PICA infarct with hydrocephalus
Incoordination and unsteadiness for 48 hours. Now drowsy.
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A large established infarct involves the left cerebellar hemisphere in the PICA territory. There is significant mass effect with effacement of the fourth ventricle and resultant hydrocephalus.
PICA infarct, patient went on to have a decompressive craniectomy and resection of infarct.