Neuro / Head & Neck for Tuesday, June 2nd, 2026

Contributed by Emory University
Ayushi Gupta, Dr Darragh Brady, and Dr Kartik Reddy.

History

A 21-month-old female with Dandy–Walker phenotype and global developmental delay presented with decreased oral intake, intermittent fevers, and reduced activity. Prior neonatal MRI showed congenital brain abnormalities without mass lesions.

Images (Click any image to enlarge)

Day 1
21 months; Stable Dandy–Walker malformation. New heterogeneously hypodense lesion in the left cerebellar hemisphere concerning for mass. Additional hyperattenuating nodular areas with curvilinear calcification in the right posterior fossa, indeterminate (lesion vs vascular/dysplastic). No significant mass effect or hydrocephalus.
21 months; Right extra-axial diffusion-restricting cerebellar mass (epidermoid vs high-grade neoplasm). Left intra-axial cystic–solid cerebellar mass with low-grade features. No metastases. Background complex brain malformations (Dandy–Walker spectrum, polymicrogyria, septal agenesis)

Question

What is the most likely explanation for two cerebellar masses with differing imaging characteristics in this patient?

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Correct answer

Check back 5 hours 29 minutes from now (after 7:00pm) for the answer and further discussion!