52 year old Indian gentleman, with no known medical illness, admitted with history of severe headache for the past 1 month, and persistent vomiting for 1/7. He was admitted with full GCS with positive left cerebellar sign. Otherwise vital signs was stable. NO history of ENT discharge. Clinically afebrile. RBS 5.3mmol/l. TWBC 11.0. CT scan plain, subsequently proceeded with contrast study revealed ring enhancing lesion at left cerebellar region with displacement of 4th ventricle and obstructive hydrocephalus.
Right frontal burrhole and ETV was performed and omaya placement after ETV. Post ETV CT scan showed smaller ventricles.MRI was planned the next day, however his GCS deteriorated to E1V2M5. He was intubated and ventilated. A repeat CT scan done showed similar findings with worsening of hydrocephalus. Emergency posterior fossa craniectomy was performed. Intra-operatively noted with encapsulated cerebellar abscess with thick capsule wall and frank pus content. A complete excision of the abscess was performed. Omaya was removed and EVD placement was performed. Subsequently EVD was removed after a repeat CT scan showed resolved hydrocephalus with visualization of 4th ventricle and minimal edema over left cerebellar. He was extubated and GCS improved to full.