Temporal cavernoma with post-op SDH

Case contributed by A.Prof Frank Gaillard

Presentation

Temporal lobe epilepsy.

Patient Data

Age: 55
Gender: Male
Modality: MRI

In the left parahippocampal gyrus is a peripherally hemosidering lined lesion consistent with a cavernous malformation. 

They went on to have a resection. 

Histology

MICROSCOPIC DESCRIPTION: Sections show a nidus of thin walled vessels with a back-to-back arrangement and containing blood clot. Vessel walls are composed of homogenous hyalinised collagen. The adjacent brain parenchyma contains abundant haemosiderin laden macrophages, consistent with previous haemorrhage. There is associated mild gliosis. There is no evidence of malignancy. The features are of cavernous haemangioma.

DIAGNOSIS: Cavernous haemangioma.

Post op MRI 3 months later

Modality: MRI

A left-sided craniotomy is noted, with post surgical change extending through the temporal lobe to the site of previous cavernous malformation, which now appears resected with no convincing residual cavernoma evident, and only a small amount of residual haemosiderin staining. A 17mm deep subdural collection extends over the left cerebral convexity exerting significant local mass effect and 5 mm midline shift. The remainder of the brain is unremarkable.

Modality: CT

Left temporoparietal craniotomy noted. Left cerebral convexity subdural haematoma is mostly isodense to brain parenchyma and measuring up to 20 mm in depth. Mass-effect with effacement of the left cerebral sulci, effacement of the body and trigone of the left lateral ventricle and midline shift towards the right up to 5 mm at the septum pellucidum.

No CT evidence of acute cortical ischaemia. No hydrocephalus.

Case Discussion

Cavernomas are quite epileptogenic and thus a lesions worth carefully seeking when evaluating a patient with epilepsy. In this case not only is the cavernous malformation large but also closely related to the hippocampus. 

Post operative subdural hematoma with a good example of isodense collection on CT. 

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Case Information

rID: 28910
Case created: 21st Apr 2014
Last edited: 15th Jun 2016
Inclusion in quiz mode: Included

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