Superior cerebellar artery infarction from contralateral brain swelling
Presentation
Previously healthy infant now comatose, no known trauma and no external evidence of trauma,
Patient Data
Left holohemispheric acute subdural hematoma. Left hemisphere decreased attenuation with 1 cm left-to-right shift. Left uncal and transtentorial herniation. Decreased attenuation in the right frontal lobe anteriorly and near the vertex. Decreased attenuation right superior cerebellum.
Increased signal in most of the left hemisphere and in the right hemisphere frontal lobe anteriorly, near the vertex, putamen, head of caudate, and superior cerebellum.
Left skull craniectomy, left brain herniation through the gap. Acute and subacute hemorrhage left hemisphere near the vertex and above the tentorium. Vertex scalp swelling.
Encephalomalacia of most of the left hemisphere and of the right hemisphere in the territory of the anterior cerebral artery circulation. Encephalomalacia of the right superior cerebellum.
Replaced left skull fragment.
Ex vacuo enlargement of third ventricle and lateral ventricles, left more than right.
Case Discussion
This 8 month old had no external scalp or body injury and no broken bones. It is not clear if the child developed the large left acute subdural hematoma and brain swelling from a dural AVF or from an unreported inflicted or accidental injury.
As a complication of the dramatic left brain swelling, the child developed contralateral infarction of the right superior cerebellar artery.