Figure 2. A 59-year-old male presented with alternating levels of consciousness, difficulties with balance, vision and hearing found to have a 2.2 cm transverse × 2.1 cm anteroposterior × 4.2 cm craniocaudal, heterogeneously-enhancing mass in the fourth ventricle. The mass extends out of the foramen of Megendie and foramen of Luscka extending inferiorly to the level of C2 and causing fourth ventricular outflow obstruction. This resulted in enlargement of the entire ventricular system. Patient was treated with suboccipital craniotomy with C1 laminectomy. (A) Lesion is hyperintense to gray matter on the axial T2-weighted image. (B) Lesion enhances heterogeneously on the axial T1-weighted image after contrast administration. (C) Lesion enhances on the coronal T1-weighted post-contrast image.