Headache and vomiting. History of previous V-P shunt placement for hydrocephalus
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Right cerebellar cystic lesion with solid mural nodule that displays moderate contrast enhancement. Associated bilateral subdural hematomas from recurrent V-P shunt placements are noted.
DD of cystic lesion with enhancing mural nodule includes pilocytic astrocytoma (children), hemangiomblastoma (adults or child with VHL), medulloblastoma underwent cystic degeneration, ependymoma and pleomorphic xanthastrocytoma PXA. The patient went on to have a craniotomy and biopsy, which confirmed the diagnosis of pilocytic astrocytoma grade I.