case_images: PMC10788140_01
case_images: (a) T2WI-FLAIR shows a subtle area of hyperintensity in the posterior region of the cerebellar vermis (arrow). There is no evidence of restricted diffusion, suggesting probable vasogenic edema. (b) Contrast-enhanced T1WI reveals pachymeningeal diffuse thickening and enhancement in the falcotentorial posterior region (arrow).. T2WI: T2-weighted imaging; FLAIR: fluid-attenuated inversion recovery; T1WI: T1-weighted imaging.
case_images: cureus-0016-00000052267-i01.jpg
case_images: PMC10788140_01_cureus-0016-00000052267-i01.jpg
case_images: FIG1
case_images: However, the patient felt that her symptoms were atypical and requested a cerebral magnetic resonance imaging (MRI) that revealed a lesion in the superior vermis of the cerebellum, involving the cuneus, hyperintense on T2-weighted images (WI) and hypointense on T1-WI, with minimal mass effect and no contrast enhancement (Figure 1).
case_images: Two weeks later, (a) T2WI shows an increase in hyperintensity in two-thirds of the superior vermis and adjacent areas, indicating an increase in vasogenic edema (arrow). (b) Contrast-enhanced T1WI shows an increase in irregular pachymeningeal enhancement adjacent to the cerebellar vermis, without restricted diffusion (arrow).. T2WI: T2-weighted imaging; T1WI: T1-weighted imaging.
case_images: cureus-0016-00000052267-i02.jpg
case_images: PMC10788140_01_cureus-0016-00000052267-i02.jpg
case_images: FIG2
case_images: It suggested an inflammatory process, possibly granulomatous, with the involvement of the cerebral venous sinuses (Figure 2).
case_images: Five weeks after the initial cerebral MRI, (a) T2WI-FLAIR shows a reduction in edema in the vermis (arrow). (b) Contrast-enhanced T1WI reveals a decrease in pachymeningeal enhancement (arrow).. T2WI: T2-weighted imaging; FLAIR: fluid-attenuated inversion recovery; T1WI: T1-weighted imaging.
case_images: cureus-0016-00000052267-i03.jpg
case_images: PMC10788140_01_cureus-0016-00000052267-i03.jpg
case_images: FIG3
case_images: Five weeks after starting treatment, the lesion had regressed in MRI (Figure 3).
case_images: One year after the initial cerebral MRI, (a) T2WI shows complete resolution of the signal alteration in the vermis (arrow), medial cerebellar hemispheres, and occipito-polar region (edema). (b) Contrast-enhanced T1WI reveals reduced thickening and pachymeningeal enhancement previously observed in the region of the torcula (arrow).. T2WI: T2-weighted imaging; T1WI: T1-weighted imaging.
case_images: cureus-0016-00000052267-i04.jpg
case_images: PMC10788140_01_cureus-0016-00000052267-i04.jpg
case_images: FIG4
case_images: She completed 12 months of anti-tuberculosis treatment, and a follow-up MRI one year after the initiation of treatment revealed a significant improvement in the dural thickening and the disappearance of the previously observed imaging abnormalities (Figure 4).