35 years old patients presents with complaints of headache, vomiting (raised ICT) and ataxia. MRI findings are well - demarcated cysric lesion with a mural nodule in the right cerebellar hemisphere with homogenous contrast enhancement. The most likely diagnosis is:
B i.e. Hemangioblastoma Well demarcated cystic lesion with a mural nodule in cerebellar hemisphere (1/t raised ICT = nausea, vomitting, headache, dizziness, veigo and cerebellar features like ataxia or disequilibrium) may be caused by JPA and HB and is differentiated by Juvenile Pilocytic Astrocytoma (JPA) Hemangioblastoma (HB) * Seen typically in children & young adults * Present typically in young adults to middle age with a (adoleseents), with most becoming symptomatic during peak incidence in 3rd to 5th decade of life (20 to 50 years first two decades ( age) and are rare in children. When a/w von Hippel with NF-1, it presents earlier in slightly younger (2-3 Lindau syndrome, HB are multiple and become years) children. symptomatic at an earlier age (29-39 yrs). * Intratumoral calcification is occasionally seen (5-25%), but despite prominent vascularity hemorrhage & necrosis are rare * Vascularity is more but calcification is lesser than JPA * On MRI, cystic poion more than mural nodule appears * On MRI, cystic poion is homogenously hypointense on hyperintense on T2 and hypointense to isointense on Ti and hyperintense on T2 images (like JPA). Mural TI. images. Cystic poion is homogenous whereas nodule is more variable most are inhomogenously mural nodule in some cases with calcification may l/t isointense/hypointense on Tl and slightly hyperintense heterogenous appearance (although most are on T2 images homogenous). * Prominent serpentine flow (signal) voids are * Homogenous contrast enhancement is characteristic characteristic but calcific focus does not enhance and may l/t * Contrast enhancement of mural nodule is heterogenous or variable enhancement (although characteristically homogenous and intense on Ti uncommon but relatively more common than HB). images.
Ependymoma
Hemangioblastoma
Pilocytic-Astrocytoma
Medulloblastoma