Presentation
Signs of raised intracranial pressure.
Patient Data
Wel-defined rounded mass centered on the tectal plate and compressing the aqueduct of Sylvius and midbrain. It displays a heterogeneous high signal on T1, FLAIR and T2 with a peripheral rim of low signal on T2 and a prominent blooming on the GE sequence. Minimal surrounding edema is noted on the FLAIR sequence. No enhancement was seen on the postcontrast sequence.
Dilated 3rd and lateral ventricles with transependymal edema in keeping with obstructive hydrocephalus.
A few CT cuts were performed after the MRI exam showing a tectal plate mass isodense to the brain parenchyma with hyperdense peripheral rim, compressing the aqueduct of Sylvius with secondary triventricular obstructive hydrocephalus.
Case Discussion
MRI and CT features are most consistent with tectal plate cavernoma with recent bleed within, compressing the aqueduct of Sylvius with secondary obstructive hydrocephalus.
Brainstem cavernomas are relatively rare and represent < 20% of intracerebral cavernomas 1. They have a high risk of bleeding and a high rate of morbidity 1. Tectal plate cavernomas are rarely described in the literature 1.
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