Cavernous malformation of the corpus callosum

Case contributed by Dr Amro Omar

Presentation

Seizure.

Patient Data

Age: 10 years
Gender: Female
  • T1WI: "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: cerebral cavernous malformation

Terminology

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

Imaging

  • 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
    • 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
  • angiography is usually normal ("angiographically occult vascular malformation") unless the lesion is extradural

Differential considerations include:

  • arteriovenous malformation
  • hemorrhagic neoplasm
  • calcified neoplasm
  • hypertensive microbleeds
  • cerebral amyloid angiopathy
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Case information

rID: 32438
Published: 26th Nov 2014
Last edited: 12th Feb 2019
Inclusion in quiz mode: Included

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