Cerebral cavernous malformation

Case contributed by Dr Mohammad A. ElBeialy

Presentation

70 yrears old female with headache and seizures.

Patient Data

Age: 70 years
Gender: Female
Modality: MRI

 

  • a left anterior-frontal subcortical ovoid 2 X 1.5 cm haemorrhagic lesion is seen, it demonstrates heterogenous, predominantly hyperintense T1 and T2 signal intensity (met Hb signal of subacte blood) with T2 hypointense rim (haemosidrin ring). The lesion is associated with no significant vasogenic brain edema or mass effect.
  • left high anterior frontal cortical and subcortical small area of T2 / FALIR hyperintensity are seen with no restricted diffusion (small vessel disease).
  • normal MRA of the brain

 

 

Case Discussion

This case demonstrated a typical cerebral cavernous malformation (cavernoma)

A popcorn-like lesion with T2 hypointense ring of haemosiderin is virtually diagnostic of cavernous malformation (cavernoma) of the brain.

Cavernous malformations (cavernoma) could be multiple, so T2* or SWI-GRI sequence must be done particularly in patients with spontaneous hemorrages. 

The annual hemorrhage was 0.6% in patients who never had a symptomatic hemorrhage. Patients who had prior hemorrhage have a higher (4.5%) annual hemorrhage rate.

The differential diagnosis of popcorn- likle lesions are: A-V malformation, haemorrhagic and calcified neoplasms. 

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Case Information

rID: 26177
Case created: 4th Dec 2013
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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