Presentation
Sudden onset headache. No vomiting, photophobia or neck stiffness.
Patient Data
There is a faint, ill-defined focus of increased attenuation in the right occipital white matter. This is of uncertain significance. It may represent a small cavernoma, subacute parenchymal hemorrhage or artefact.
The brain parenchyma and CSF spaces are otherwise normal. No space-occupying lesion, subarachnoid hemorrhage or hydrocephalus.
There is a cluster of well-defined, high T2-weighted "bubbly" foci in the subcortical white matter of the posterior right parietal and anterior right occipital lobes. There is no suppression on FLAIR. The overlying cortex is not thickened. There is no abnormal restricted diffusion or contrast enhancement.
The brain parenchyma and CSF spaces are otherwise normal. No evidence of cavernoma or parenchymal hemorrhage.
Case Discussion
Well-defined, "bubbly" T2-weighted hyperintense foci in the subcortical white matter are typical MRI features of multinodular and vacuolating neuronal tumor (MVNT). MVNTs can cause seizures or be identified incidentally. It can be difficult to identify on CT.
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