case_images: PMC11301786_01
case_images: A well-defined extra-axial midline posterior fossa lesion along the vermis. The lesion demonstrated (a) hyperintense signal on sagittal T2W imaging, (b) no significant post contrast enhancement on sagittal T1W scan, (c) no hydrocephalus, (d) incomplete suppression of signal on T2-FLAIR sequences, (e) with diffusion restriction on DWI, and (f) low ADC signal. T2W: T2 weighted, T1W: T1 weighted, FLAIR: Fluid-attenuated inversion recovery, DWI: Diffusion-weighted imaging, ADC: Apparent diffusion coefficient.
case_images: SNI-15-230-g001.jpg
case_images: PMC11301786_01_SNI-15-230-g001.jpg
case_images: F1
case_images: A 9-year-old, 20 kg female with a midline posterior fossa lesion was posted for midline sub-occipital craniotomy and lesion decompression [Figure 1].
case_images: Intraoperative hemodynamic chart illustrating persistent hypotension followed by blood pressure stabilization on steroid administration (blue arrow represents time point of steroid administration, ARTsys: Systolic arterial blood pressure, HR: Heart rate).
case_images: SNI-15-230-g002.jpg
case_images: PMC11301786_01_SNI-15-230-g002.jpg
case_images: F2
case_images: Post induction (5-6 h after dexamethasone), the child developed resistant hypotension, with blood pressure (BP) dropping from 121/86 mmHg (post-intubation) to 74/40 mmHg, while heart rate (HR) consistently stayed within 10-20% of baseline (90 beats/min) [Figure 2]. Following this, BP improved significantly, and vasopressors could be tapered [Figure 2].