Atypical presentation of acute cerebellar infarct as Lhermitte-Duclos disease

Cerebellar infarct resembling Lhermitte-Duclos disease (LDD) is a rare case scenario. LDD being a rare, slowly growing cerebellar tumor is generally characterized by headaches, ataxia, cranial nerve palsies, and impaired cerebellar symptoms. Primarily diagnosed with a magnetic resonance imaging, the lesion has several differential diagnoses, including vascular malformation with cerebellar venous congestion, rhombencephalosynapsis, cerebellar dysplasia, and medulloblastoma. In unusual instances, a cerebellar stroke may mimic LDD, potentially leading to a delay in management.

We present a case of a 49-year-old female with complaints of headache and vomiting for 5 days with no previous similar history. Based on the initial impression and classical imaging findings, LDD was diagnosed, and she was managed conservatively. Even though the majority of patients with LDD develop the disease over a course of time, some cases have been reported to show acute presentation. However, on worsening of symptoms, with extension of lesion on repeat imaging, an emergency craniotomy was performed, and biopsy revealed an acute infarct with hemorrhagic transformation.

Various neurological conditions can imitate LDD and vice versa. We recommend that a cerebellar stroke should be ruled out when encountering with a radiological diagnosis of LDD, to avoid critical delays in the management of stroke.