History: 8 years old with sudden onset of headache.
Findings:
CT Head: A small volume of intraventricular haemorrhage is demonstrated in the inferior recesses of the 4th ventricvle. Although the ventricles are not grossly enlarged, they are disproportionately prominent compared with the supratentorial sulci, and have a morphology in keeping with mild acute hydrocephalus.
MRI Spine: At T1/T2 there are extramedullary tubular hypointensities consistent with flow voids, which extend over the anterior surface of the cervical spinal cord. These appear at least in part to also extend to the intramedullary compartment, although the quality of axial images makes further assessment difficult.
Opinion: Intraventricular haemorrhage secondary to a spinal vascular anomaly. In a patient of this age, this is likely to represent an arteriovenous malformation rather than a dural arteriovenous fistula. Discussion with interventional neuroradiology is recommended, with a view to spinal angiography to further characterise the lesion.