Pontine cavernoma with tractography

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Headache, lower limb weakness and visual disturbance.

Patient Data

Age: 50
Gender: Male
MRI

MRI brain

A rather defined (2.2x1.6x1.5 cm) "popcorn ball like" lesion is noted at posterior portion of the pons along the midline inclined to the left side and partially encroaching upon the inferior aspect of the midbrain. It displays T1 heterogeneous intensity with multiple foci of hyperintensity, T2 hyperintense signal, with hypointense hemosiderin ring and few fluid-fluid levels. Following intravenous contrast injection the lesion shows modest enhancement. On SWI the lesion shows marked blooming. No other similar lesions seen. Mild mass effect is exerted manifested as indentation of the anterior aspect of the fourth ventricle.

MRI

Diffusion tensor imaging (tractography)

The cotico-spinal tracts are anterior to cavernoma with no displacement or fibers attenuation. The medial leminsicus on both sides are mildly displaced laterally with no fibers attenuation.

Case Discussion

MRI features are in favor of cavernous malformation "cavernoma" at the posterior aspect of the pons "Zabramski type 2". The cotico-spinal tracts are anterior to cavernoma with no displacement or fibers attenuation. The medial leminsicus on both sides are mildly displaced laterally with no fibers attenuation. MRI is the modality of choice, demonstrating a characteristic “popcorn” or "berry" appearance with a rim of signal loss due to haemosiderin

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Case information

rID: 53896
Case created: 12th Jun 2017
Last edited: 17th Jun 2017
Inclusion in quiz mode: Included

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