case_images: PMC6159180_01
case_images: Non-contrast CT brain demonstrating bilateral supratentorial hyperdense punctate haemorrhagic foci. The largest lesion was infratentorial, in the right cerebellar hemisphere (depicted on MRI images).
case_images: bjrcr.20170028.g001.jpg
case_images: PMC6159180_01_bjrcr.20170028.g001.jpg
case_images: f1
case_images: The general practitioner arranged a CT brain, which identified multifocal haemorrhagic sites in the right cerebellar and both cerebral hemispheres (Figure 1).
case_images: Maximum intensity projection susceptibility weighted image sequence (mIP SWI) MRI demonstrating haemosiderin deposition in the cerebral sulci.
case_images: bjrcr.20170028.g002.jpg
case_images: PMC6159180_01_bjrcr.20170028.g002.jpg
case_images: f2
case_images: Haemosiderin staining was seen in multiple sulci at the vertex in keeping with a low volume of subarachnoid blood, and a 4 mm posterior inferior cerebellar artery aneurysm was detected (Figures 2-4).
case_images: Non-contrast T1 (left) and T2 (right) images at the level of an irregular ring- like lesion in the right cerebellar hemisphere. The lesion demonstrates low T1 signal and high T2 signal, compatible with a metastasis. Classically a melanoma deposit would demonstrate high T1 signal. Hyperintense T1 and T2 material surrounding the lesion is in keeping with subacute haemorrhage. Note the additional site of haemorrhage in the inferior right occipital lobe, seen on the sagittal slice.
case_images: bjrcr.20170028.g003.jpg
case_images: PMC6159180_01_bjrcr.20170028.g003.jpg
case_images: f3
case_images: Haemosiderin staining was seen in multiple sulci at the vertex in keeping with a low volume of subarachnoid blood, and a 4 mm posterior inferior cerebellar artery aneurysm was detected (Figures 2-4).
case_images: Post contrast T1 weighted stealth MRI sequence demonstrating bilateral enhancing cerebellar lesions and an avidly enhancing aneurysm arising adjacent the posterior wall of the fourth ventricle (arrow). The lesions are suspicious for metastases.
case_images: bjrcr.20170028.g004.jpg
case_images: PMC6159180_01_bjrcr.20170028.g004.jpg
case_images: f4
case_images: Haemosiderin staining was seen in multiple sulci at the vertex in keeping with a low volume of subarachnoid blood, and a 4 mm posterior inferior cerebellar artery aneurysm was detected (Figures 2-4).
case_images: Post contrast, non-gated staging CT Chest showing a left atrial mass, concerning for cardiac myxoma.
case_images: bjrcr.20170028.g005.jpg
case_images: PMC6159180_01_bjrcr.20170028.g005.jpg
case_images: f5
case_images: The CT chest identified a mass in the left atrium concerning for an atrial myxoma (Figure 5).
case_images: Digital subtraction angiography confirming aneurysm formation. The largest aneurysm is located in a peripheral branch of the right anterior cerebral artery (highlighted by arrow).
case_images: bjrcr.20170028.g006.jpg
case_images: PMC6159180_01_bjrcr.20170028.g006.jpg
case_images: f6
case_images: Distal, fusiform aneurysm formation was identified in at least two distinct sites in the peripheral intracranial branches (Figure 6,7).