Cerebellum Question

[vir0n]

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Came across a question the other day, but never got the answer and was hoping the professionals here could help.

It was a straight-up pathology picture question asking what was wrong with the patient. The picture was a gross hemisection of the cerebellum + brainstem showing what appeared to be petechiae ("bright red dots") throughout the cerebellem. It then looked like there was some spinal canal stenosis a la arnold-chiari malformation (the cerebellum had a nice little ventral-posterior tail). The answers that stood out were:

a. hemorrhage
b. hydrocephalus

I went with hydrocephalus, but the petechiae threw me off. Anyone have an idea of what was going on here? My apologies for the lack of details

 

[EBI831]

they weren't lacunar infarcts with resultant hemorrhaging from hypertension? that's a classic picture of lacunar infarcts...lots of little red dots in the thalamus or cerebellar area.

 

[thethom]

Hypertensive hemorrhage should typically be in the most common location (lenticulostriate branches of the MCA) in the globus pallidus/putamen area.

If there was a SIGNIFICANT "cerebella tail" aka enlarged cerebellar tonsils(obstruction of the foramina of luschka and magendie), then hydrocephalus was more likely. Keep in mind that the tonsils must extend 5mm below the foramen magnum to meet the criterion for chiari malformation.

 

[vir0n]

Hypertensive hemorrhage should typically be in the most common location (lenticulostriate branches of the MCA) in the globus pallidus/putamen area.

If there was a SIGNIFICANT "cerebella tail" aka enlarged cerebellar tonsils(obstruction of the foramina of luschka and magendie), then hydrocephalus was more likely. Keep in mind that the tonsils must extend 5mm below the foramen magnum to meet the criterion for chiari malformation.

I was thinking along the same lines - cerebellum wouldn't be the first place for a lacunar. I swear the canal looked blocked, I didn't really see any raging dilation of the 4th ventricle though. Those bright red (I'm talking eosinophilic red) spots in the cerebellum are eating at me.

 

[LunaMD]

Duret Hemorrhages?