Cavernous hemangioma of the cerebellar falx

Case contributed by Dr Muhammad Shoyab

Presentation

Headache

Patient Data

Age: 60 years
Gender: Female
CT

CT Brain (Non-Contrast)

A large (5.3 x 3.6 x 3.7 cm) well-defined midline-centered mass is identified posterosuperior to cerebellum, producing apparent splitting of the falx cerebelli. It has a sharp lobulated outline, containing multiple loculi of mixed hyper & hypodense appearance. The mass compresses upon cerebellar vermis & both hemispheres as well as fourth ventricle. Rest of the ventricles and extraventricular CSF spaces appear widened.

MRI

MRI Brain with I/V Gadolinium

A large (5.3 x 3.6 x 3.7 cm) well-defined midline-centered mass is identified posterosuperior to cerebellum, producing elevation of straight sinus, associated with sideways splitting and forward bulging of the falx cerebelli.

After administration of I/V gadolinium, the split layers of falx cerebelli are well-identified wrapping around the lateral & anterior surfaces of the mass — confirming its location within the falx cerebelli. The mass itself and its walls show minimal or no enhancement.

The mass is outlined by a well-defined lobulated outline containing multiple loculi. The loculi demonstrate mixed iso-, hyper- & hypo-intense as well as a signal-void appearance on T1, T2 & FLAIR images, followed by blooming on BOLD images, thus representing hemoglobin derivatives and blood-blood levels.

The mass compresses upon cerebellar vermis & both hemispheres as well as fourth ventricle. An ill-defined thin hyperintense zone of perilesional edema is seen along the compressed posterior surface of cerebellum.

Rest of the ventricles and extraventricular CSF spaces appear widened. However, no diffuse hyperintensity is noted in paraventricular white matter.

Case Discussion

Cerebellar falx is an extremely rare location for cavernous hemangiomas, also known as cavernomas. Although cavernomas can occur anywhere in the body, the commonest CNS site is subcortical white matter. Extra-axial cavernomas are very rare, and even less common in the posterior cranial fossa (about 15 reports up to 2018). Among these 15, only 2-3 were reported involving the cerebellar falx, and the rest arose from the tentorium.

As such, this present case is among the very unique.

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Case information

rID: 73025
Published: 1st Jan 2020
Last edited: 14th Jun 2020
Inclusion in quiz mode: Included
Institution: Al Haramain Hospital Pvt Ltd

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