Upward transtentorial herniation due to cerebellar metastasis
PH breast Ca, now headache and reduced conscious state with cerebellar signs
Post contrast CT brain
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Upward herniation of the superior vermis through the tentorial hiatus (arrow) together with oedema in the brain stem causing aqueduct obstruction (arrow) and resultant lateral and 3rd ventricular dilatation with periventricular (interstitial) oedema due to the rapidity of onset. Note large enhancing mass in the left cerebellar hemisphere (metastasis) responsible for the mass effect.