Presentation
History of headache.
Patient Data
Well-defined multilobulated lesion is noted in the right thalamocapsular region partially involving the right middle cerebral peduncle and the right paramedian and lateral aspects of midbrain.
It appears homogeneously hyperintense medially and iso to mildly hyperintense laterally on T1 weighted images. It appears hyperintense on T2 weighted images with mild iso-hypointense shading. It is causing mass effect with compression on the 3rd ventricle mildly bulging into the left paramedian midbrain. It is effacing the right crura and partially effacing the interpeduncular cistern. There is peripheral hypointense rim medially on GRE and SWI images suggestive of hemosiderin rim. The lateral aspect of the lesion shows lobulated blooming artifacts on GRE images, suggestive of hemorrhagic component. There is enhancement along the hemorrhagic component laterally.
A multilobulated lesion in the right thalamocapsular region partially involving the middle cerebral peduncle & midbrain appearing hyperdense on its lateral aspect suggestive of hemorrhagic component and hypodense on its medial aspect with peripheral hyperdense rim medially and causing mass effect on the 3rd ventricle.
Case Discussion
Cerebral cavernous venous malformation, also known as cavernous hemangioma or cavernoma is a vascular abnormality of the central nervous system. It contains blood products at various stages of evolution. It is usually less than 3 centimeters in size.
Up to 25% of patients present with hemorrhage which can cause headache, followed by neurological symptoms or decreased level of consciousness. Risk of bleed increases with deep brainstem lesions. CT findings consists of iso to high density lesion, maybe partially calcified. MRI findings consist of mixed-signal intensity with peripheral hemosiderin rim and depending on the intralesional stage of hemorrhage.
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