Concluded Case

Hemorrhagic Metastasis Renal cell carcinoma

New case 56yr ,M,presented with Rt occipital head ache since 2 weeks and feeling of unsteadiness since 10 days. For the last2 weeks he has been getting dull aching type of head ache rt occipital area with out any nausia,vomiting or vertigo. Intermittent head ache and occasionally taking paracetamol.Since 10 days he has difficulty in walking while passing narrow path like going in and out to toilet he has tendency to hit the side wall. Regarding the past history known hypertensive 10 yrs ,CAD ,CKD ,rt nephrectomy done for Renal cell CA 2015. On exam vitals stable. BP140/ 80 mm Hg. Gaze evoked nystagmus fast component to Rt . Gr 5/ 5 power with intact DTRs.Mild rt upper limb incordination . Gait ataxia the tendency to fall to the Rt side. Diagnosis and Management.

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Concluded answer

Thanks for all answeres. MRI brain : Relatively well defind irregular heterogeneously hyperdense lesion in the Rt cerebellar hemisphere and vermis with cystic areas,intense areas of blooming ,heterogeneous contrast enhancement with perilesional edema. mass effect on 4th ventricle and brain stem Mild upstream hydrocephalus involving lateral and 3rd ventricles. Imp - Hemorrhagic metastasis. After consultation with cardiologist,Radiation Oncologist Vp Shunt ,sub occipital craniotomy and decompression of rt cerebellar tumor done under GA. HPR- Hemorrhagic metastasis - Renal cell carcinoma. Neurologically well stable. Follow up with Oncologist

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Thanks for all answeres. MRI brain : Relatively well defind irregular heterogeneously hyperdense lesion in the Rt cerebellar hemisphere and vermis with cystic areas,intense areas of blooming ,heterogeneous contrast enhancement with perilesional edema. mass effect on 4th ventricle and brain stem Mild upstream hydrocephalus involving lateral and 3rd ventricles. Imp - Hemorrhagic metastasis. After consultation with cardiologist,Radiation Oncologist Vp Shunt ,sub occipital craniotomy and decompression of rt cerebellar tumor done under GA. HPR- Hemorrhagic metastasis - Renal cell carcinoma. Neurologically well stable. Follow up with Oncologist

Right cerebellar infarct

Thank you doctor
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