PMC5502298_01
(a and b) Non contrast axial computed tomographic scan suggesting subarachnoid, intraventricular, and intraparenchymal hemorrhage in the posterior fossa
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F1
Coma Scale (GCS) was 4. Computed tomographic (CT) image [Figure 1] showed a large volume subarachnoid hemorrhage of the posterior fossa with a small amount of intraventricular extension and intraparenchymal hemorrhage involving the right cerebellar tonsil.
(a) Axial T1 magnetic resonance imaging with contrast showing vermian hemangioblastomas. (b) Axial T1 magnetic resonance imaging with contrast showing 4th ventricular hemangioblastomas and cerebellar hemangioblastomas
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F2
A magnetic resonance imaging (MRI) was obtained [Figure 2] which showed the presence of three posterior fossa lesions, two of which were in proximity to the site of hemorrhage (fourth ventricular lesion and vermian lesion).
Sagital T1 magnetic resonance imaging with contrast demonstrating the 3 Hemangioblastomas preoperatively with underlying blood in the 4th ventricle
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F3
The pattern of hemorrhage did not clearly indicate if the same lesion was responsible for the hemorrhage based on MRI [Figure 3].
(a) Anteroposterior view of cerebral angiogram with right vertebral artery injection demonstrating two separate areas of tumor blush from the posterior inferior cerebellar artery. (b) Lateral view of cerebral angiogram with right vertebral artery injection demonstrating two separate areas of tumor blush from the posterior inferior cerebellar artery
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F4
A cerebral angiogram was performed demonstrating a tumor blush for the two bigger lesions, but embolization was not felt to be necessary [Figure 4].
Image b demonstrates a postoperative view after resection of the 3 hemangioblastomas with residual intraventricular hemorrhage in the 4th ventricle
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F5
Patient had surgical resection of three posterior fossa lesions during that admission with return to her baseline neurologic exam postoperatively [Figure 5].