PMC3600142_01
Axial T2-weighted imaging (WI) (a), axial T1-WI (b), axial T1-WI with gadolinium (c), and sagittal T1-WI with gadolinium (d) magnetic resonance images showing a huge tumor with intratumoral hemorrhage in the right frontal lobe that led to subfalcial and transtentorial herniation.
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Magnetic resonance imaging performed at our hospital showed a rapid increase in mass effect, resulting in subfalcial and transtentorial herniation (Figure 1).
((a), (b)) Computed tomography (a) and axial T2*-weighted imaging (WI) magnetic resonance (b) images on postoperative day 1 showing a bilateral cerebellar hemorrhage along with the cerebellar sulci facing the tentorium. (c) Axial T1-WI with gadolinium showing no evidence of residual tumor in the surgical site. ((d), (e)) Axial diffusion-weighted imaging (DWI) revealing bilateral anterior cerebral artery infarction due to subfalcial herniation (d) and right posterior cerebral artery infarction due to transtentorial herniation (e) that reflected the preoperative intracranial hypertension. (f) Follow-up computed tomography image showing no further progression of hemorrhage.
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A routine postoperative CT scan on the day after surgery revealed a bilateral cerebellar hemorrhage along with the cerebellar sulci facing the tentorium (Figure 2(a)). Magnetic resonance imaging showed bilateral anterior cerebral artery infarction due to subfalcial herniation and right posterior cerebral artery infarction due to transtentorial herniation that reflected the preoperative intracranial hypertension, and no evidence of residual tumor at the surgical site was found (Figures 2(c)-2(e)). A follow-up CT scan demonstrated no further progression of hemorrhage and no occurrence of obstructive hydrocephalus due to compression of the fourth ventricle by the associated edema (Figure 2(f)).