Cerebral cavernous venous malformations

Case contributed by A.Prof Frank Gaillard

Presentation

Facial twitching

Patient Data

Age: 25 years
Modality: CT

A peripherally lobulated hyperdense lesion with central round areas of hypodensity within the anterosuperior aspect of the pons appears to have minor enhancement. No supplying artery or draining vein identified. No surrounding edema. No positive nor negative mass effect. On the sagittal plane, it appears wedge like.

A second area of focal hyperdensity adjacent to the left occipital horn of the lateral ventricle appears to layer in the axial plane but does not on the sagittal plane. 

Conclusion: The pontine lesion most likely represents a low flow vascular malformation (i.e. cavernoma or mixed cavernoma/telangietasia). Tumour is thought less likely.

Dependent left occipital horn lesion probably does not represent intraventricular blood, but rather a second cavernoma. 

Modality: MRI

In the anterior aspect of the pons, in the midline, is and a lesion with heterogeneous central signal, and the prominent peripheral complete haemosiderin ring, which demonstrates blooming on susceptibility weighted imaging. These features are characteristic of a cavernous malformation. No abnormal vessels are demonstrated in the area, and certainly no features to suggest an AVM.

A second similar lesion is demonstrated abutting the occipital horn of the left lateral ventricle, also characteristic of a cavernous malformation, which mimic to the appearance of intraventricular blood on CT. No the lesion demonstrates a surrounding oedema to suggest recent haemorrhage. Remainder of the brain is unremarkable in appearance. MRA is normal.

Conclusion

Features are characteristic and pathognomonic of two cavernous malformations (cavernomas). 

Case Discussion

The occipital horn 'blood' can easily be confused with intraventricular haemorrhage on CT, but careful review of sagittal images conclusively shows that this is not the case. 

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Case Information

rID: 48117
Case created: 19th Sep 2016
Last edited: 25th Apr 2017
Inclusion in quiz mode: Included

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