Multiple cavernous malformations (brainstem and cerebellum)

Case contributed by Dr Bruno Di Muzio

Presentation

Headaches.

Patient Data

Age: 35 years
Gender: Female

Thre are a few hyperdense foci within the pons, right middle cerebellar peduncle, and right cerebellar hemisphere, associated with a developmental venous anomaly, that are in keeping with venous vascular malformations, likely cavernomas.  

The patient happens to be already on follow-up in another institution due to mixed vascular malformations in the posterior fossa. A new MRI was then performed and compared to a previous study (not shown). 

Multiple nodular lesions with heterogeneous signal and marked blooming artefact are demonstrated within the pons and right cerebellar hemisphere. A new similar focus that exhibits marked bright T1 signal is demonstrated in the right middle cerebellar peduncle, in keeping with a more recent bleeding cavernoma. The most superior left cerebellar lesion demonstrates bright T1 signal as well. There s a developmental venous abnormality in the right cerebellar hemisphere and brainstem. 

Heterogeneous slightly increased signal and swelling within the left anterolateral aspect of the medulla oblongata, consistent with the region of the inferior olivary nucleus. The supratentorial brain parenchyma is unremarkable. Ventricles and basal cisterns are normal in appearance. Right orbital enucleation / prosthetic eye. 

Conclusion: new haemorrhagic foci are demonstrated within the right middle cerebellar peduncle and cerebellar hemisphere, with no significant mass effect. Features consistent with hypertrophic olivary degeneration on the left are unchanged.

Case Discussion

This case illustrates classical appearances of mixed vascular malformations: multiple small posterior fossa cavernomas and an associated developmental venous anomaly. New bleeding within some of the lesions may be the cause for the patient current headaches. 

Also, the MRI images have shown features consistent with hypertrophic olivary degeneration on the left.

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Case information

rID: 54313
Case created: 3rd Jul 2017
Last edited: 8th Jul 2017
Tag: rmh
Inclusion in quiz mode: Included

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