We report an interesting and unique case of occipital cephalocele with herniation of the brain stem and cerebellar peduncles. Interestingly the patient had no neurological deficits. Introduction Occipital cephaloceles refer to a defect in the skull and dura with extracranial herniation of intracranial structures (1, 2) and are rare congenital malformations. They can occur in isolation or with various syndromes. We describe hereto-undescribed imaging features, in a neurologically asymptomatic child. Case Report A 5-year-old male child, born 6 weeks premature, of a non-consanguineous parentage, presented with a swelling over the right occipital region since birth. There was no history of perinatal head trauma. The swelling was soft to firm in consistency, non pulsatile and had no impulse on crying. There was no discharge or leak from the swelling. There was no increase in head circumference and the lesion remained static in size over these years. Developmental milestones were normal. Magnetic resonance imaging (MRI) was done on a 1.5 T scanner, and images obtained in various orthogonal planes with T1 and T2 weighting. In addition, high-resolution thin T2 weighted axial images at the level of the occipital swelling were also obtained. The MRI revealed kinking of the brainstem at the pontomedullary junction with a band of tissue extending posteriorly across the posterior fossa to end in the cephalocele sac. This band was a continuation of the right half of the lower part of the superior cerebellar peduncle, the entire middle and inferior cerebellar peduncle and part of the superior medulla. CSF extended around the band upto the inner occipital margin {Figure 1(A-H)}.
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