Answer for BIR CoW 07 May 2023
Remote cerebellar hemorrhage
Findings
Well defined T1/T2 heterointense lesion noted in suprasellar region showing patchy diffusion restriction with multiple blooming foci noted within the lesion The lesion causes mass effect over third ventricle and optic chiasma with upstream dilation of bilateral lateral ventricle - Suggestive of Craniopharyngioma T1,T2/FLAIR hyperintenity noted in superior cerebellar foliae, showing diffusion restriction and blooming foci on SWI imaging. Features suggestive of remote cerebellar hemorrhage
Discussion
A case of suprasellar mass diagnosed as craniopharyngioma,underwent biopsy.Post procedure patient developed remote cerebellar hemorrhage Remote cerebellar hemorrhage is a relatively benign complication of supratentorial craniotomy spinal surgery, lumbar puncture and insertion of a lumboperitoneal shunt. It is called "remote" as the cerebellar hemorrhage is far from the location of the surgery. Most patients are asymptomatic . When symptomatic, delayed awakening from anesthesia and reduced level of consciousness are the frequently reported symptoms, although cerebellar signs such as ataxia can also be present . It often tends to have a self-limiting course . Imaging: The most common CT finding is layering of blood over superior folia, called the Zebra sign, and less frequently it can be an intraparenchymal or lobar hemorrhage. Cerebellar hemorrhage can be contralateral or ipsilateral to the site of surgery, and less commonly can be bilateral or even can be isolated to the vermis. Generally no specific management is required.
References:
1. Amini A, Osborn AG, Mccall TD et-al. Remote cerebellar hemorrhage. AJNR Am J Neuroradiol. 2006;27 (2): 387-90. AJNR Am J Neuroradiol (full text) - Pubmed citation
2. Friedman JA, Piepgras DG, Duke DA et-al. Remote cerebellar hemorrhage after supratentorial surgery. Neurosurgery. 2001;49 (6): 1327-40. Neurosurgery (link) - Pubmed citation
Findings
Well defined T1/T2 heterointense lesion noted in suprasellar region showing patchy diffusion restriction with multiple blooming foci noted within the lesion The lesion causes mass effect over third ventricle and optic chiasma with upstream dilation of bilateral lateral ventricle - Suggestive of Craniopharyngioma T1,T2/FLAIR hyperintenity noted in superior cerebellar foliae, showing diffusion restriction and blooming foci on SWI imaging. Features suggestive of remote cerebellar hemorrhage
Discussion
A case of suprasellar mass diagnosed as craniopharyngioma,underwent biopsy.Post procedure patient developed remote cerebellar hemorrhage Remote cerebellar hemorrhage is a relatively benign complication of supratentorial craniotomy spinal surgery, lumbar puncture and insertion of a lumboperitoneal shunt. It is called "remote" as the cerebellar hemorrhage is far from the location of the surgery. Most patients are asymptomatic . When symptomatic, delayed awakening from anesthesia and reduced level of consciousness are the frequently reported symptoms, although cerebellar signs such as ataxia can also be present . It often tends to have a self-limiting course . Imaging: The most common CT finding is layering of blood over superior folia, called the Zebra sign, and less frequently it can be an intraparenchymal or lobar hemorrhage. Cerebellar hemorrhage can be contralateral or ipsilateral to the site of surgery, and less commonly can be bilateral or even can be isolated to the vermis. Generally no specific management is required.
References:
1. Amini A, Osborn AG, Mccall TD et-al. Remote cerebellar hemorrhage. AJNR Am J Neuroradiol. 2006;27 (2): 387-90. AJNR Am J Neuroradiol (full text) - Pubmed citation
2. Friedman JA, Piepgras DG, Duke DA et-al. Remote cerebellar hemorrhage after supratentorial surgery. Neurosurgery. 2001;49 (6): 1327-40. Neurosurgery (link) - Pubmed citation
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!