Case contributed by Bassem Marghany
Diagnosis almost certain


Headache. Recurrent vomiting for 1 week, Recent occipital craniotomy 3 weeks ago for surgical resection of right cerebellar tumor.

Patient Data

Age: 4 years
Gender: Male
  • subcutaneous/subgaleal bilocular CSF collection at the back of the head and upper nape overlying occipital craniotomy defect, with possible communication with cisterna magna (pseudomeningocele)
  • left frontoparietal subdural fluid collection (hygroma/chronic hematoma) with underlying mass effect, mild rightward midline shift, attenuation of the left lateral ventricle and mild dilatation of the right lateral ventricle (subfalcine herniation)
  • infra-tentorial right posterior fossa subdural fluid collection (hygroma)
  • right cerebellar hemisphere posterior cortical and subcortical area of encephalomalacia

Case Discussion

Right cerebellar pilocytic astrocytoma was first discovered on MRI performed 1 month ago, which was operated on and the patient had an uneventful post-op period of 2 weeks, after which another MRI was done and revealed subdural hygromas/chronic hematomas, right cerebellar encephalomalacia and pseudomeningocele. 

One week later, the patient started developing recurrent vomiting, for which non-contrast CT brain was requested. Upon the diagnosis of subfalcine herniation, urgent neurosurgical consultation was advised and the patient was submitted for surgery.

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