Complicated brain stem cavernoma and developmental venous anomaly

Case contributed by Dr Mohamed Saber

Presentation

A healthy gentleman presented acutely with left side weakness and numbness associated with mouth deviation, right eye medial deviation, and double vision started less than 1 hour.

Patient Data

Age: 35 years
Gender: Male

CT study shows a dense hemorrhagic lesion involves the right side of the pons and medulla oblongata. It appears localized with a rounded configuration of the pons component and linear of the medullary component. No associated significant mass effect.

MRI study confirms right pons and medulla oblongata hemorrhagic lesion that blooms in T2 GRE and elicits iso intensity in T1 and hyperintensity in T2 consistent with hyperacute blood. As noted in CT, the hemorrhage appears localized with no associated significant mass effect.

Follow up MRI after one month

MRI

Follow-up MRI shows right posterior pons small cavernoma (type II Zabramski classification) with associated developmental venous anomaly extends to the right medulla oblongata.

Right mastoiditis is incidentally noted.

Case Discussion

Many cerebral cavernous malformations are asymptomatic and can be treated conservatively. Symptoms can relate to mass effect, epileptic activity, or repeated hemorrhage.

This case is an example of brain stem cavernoma and developmental venous anomaly complicated by hyperacute hemorrhage.

The patient was treated conservatively with complete recovery.

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