There is obvious bilateral intraventricular hemorrhage and ventricular dilatation. Clinically, extensor posturing suggests the possibility of impending herniation. She sustains episodes of bradycardia which respond to doses of IV mannitol. A neurosurgeon decompresses her ventricles immediately. She recovers well without neurological deficits.
Subsequent studies demonstrate the presence of a choroid plexus arteriovenous malformation.
This is neurosurgically ablated. This reduces cerebral blood flow prompting reflex hypertension to maintain cerebral perfusion. As intracranial pressure increases further, the contents of the skull can no longer remain in place. Focal increases in pressure, such as with tumors and acute hemorrhages, result in focal deviations in anatomy. Identifying increases in intracranial pressure by clinical and radiographic means is important to intervene early to prevent herniation.