Cavernous malformation of the corpus callosum

Case contributed by Dr Amro Omar

Presentation

Seizure.

Patient Data

Age: 10
Gender: Female
Modality: MRI

T1W: "Popcorn ball" appearance of mixed hyper, hypointense blood-containing locules

T2WI: Reticulated popcorn-like lesion most typical, mixed signal core, complete hypointense hemosiderin rim

T2* GRE: Prominent susceptibility effect (hypointense "blooming")

Case Discussion

Diagnosis -

Terminology

  • benign vascular hamartoma
    • contains masses of closely apposed immature blood vessels ("caverns"), no neural tissue
    • intralesional hemorrhages of different ages
  • cavernous malformations exhibit a range of dynamic behaviour (enlargement, regression, de novo formation)

Imaging

  • CMs vary from microscopic to giant (> 6 cm)
  • Locules of variable size contain blood products at different stages of evolution
    • Variable appearance depending on hemorrhage/stage
  • Zabramski classification of CMs
    • type 1 = subacute hemorrhage (hyperintense on T1WI; hyper-/hypointense on T2WI)
    • type 2 = mixed signal intensity on T1, T2WI with degrading hemorrhage of various ages (classic "popcorn ball" lesion)
    • type 3 = chronic hemorrhage (hypo- to iso on T1, T2WI)
    • type 4 = punctate microhemorrhages ("black dots"), poorly seen except on T2* sequences
  • DSA usually normal ("angiographically occult vascular malformation") unless CM is extradural

Differential considerations include

  • arteriovenous malformation

  • haemorrhagic neoplasm

  • calcified neoplasm

  • hypertensive microbleeds

  • cerebral amyloid angiopathy

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Case Information

rID: 32438
Case created: 26th Nov 2014
Last edited: 7th Jan 2016
Inclusion in quiz mode: Included

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