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A 64 year-old man presented with nausea, vomiting and right sided ataxia. He was found to have a right cerebellar stroke. Two days later, he abruptly deteriorated. He was obtunded with decerebrate posturing.
Axial CT scan - note the hypodensity in the right cerebellum (left image) denoting the subacute stroke. However, in this case, the stroke has swelled, compressing the fourth ventricle. This then results in acute hydrocephalus (right image). The third ventricle which normally has the shape of a slit now becomes round. The temporal horns of the lateral ventricles become markedly enlarged. No sulci are seen over the convexity - they have been effaced by the underlying increase in pressure. This picture requires emergency neurosurgery and ventricular shunting.
Revised
04/21/06.
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School of Medicine.