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Age: 31

Sex: Male

Indication: Headache

Save ("V")

Case #3


Findings

  • 2 x 1 cm lesion centered in the right globus pallidus and 1.5 x 1 cm lesion in the right midbrain, both of which have internal T1 and T2 signal hyperintensity, peripheral T2 signal hypointensity, and blooming signal hypointensity on susceptibility weighted imaging, indicating a peripheral hemosiderin ring
  • Additional small focus of susceptibility artifact in the dorsolateral right thalamus
  • The midbrain lesion exerts mild mass effect on the cerebral aqueduct without evidence of hydrocephalus
  • Developmental venous anomaly in the right thalamus, posterior limb of the right internal capsule, and posterior right lentiform nucleus draining into a right lateral tentorial sinus
  • No significant surrounding T2/FLAIR hyperintensity
  • No evidence of acute infarct
  • Few scattered T2/FLAIR hyperintensities in the cerebral white matter
  • Multiple discrete T2 signal hyperintensities and associated patchy enhancement in the superior right orbit


Diagnosis

  • Cerebral cavernous malformations (cavernomas)

Sample Report

Cerebral cavernous malformations (cavernomas) centered in the right globus pallidus and right midbrain, both of which have internal T1 and T2 signal hyperintensity suggesting subacute hemorrhage. No significant surrounding edema. The midbrain lesion exerts mild mass effect on the cerebral aqueduct without evidence of hydrocephalus. Associated developmental venous anomaly draining into a right lateral tentorial sinus.

Additional small focus of susceptibility artifact in the dorsolateral right thalamus, which could represent an additional tiny cavernoma versus sequela of prior microhemorrhage.

No evidence of acute infarct.

Few scattered T2/FLAIR hyperintensities in the cerebral white matter, which are nonspecific and may represent sequela of chronic small vessel disease or sequela of prior trauma/inflammation/vasculopathy.

Multiple discrete T2 signal hyperintensities and associated patchy enhancement in the superior right orbit, which may represent a venolymphatic malformation. Recommend dedicated orbit MRI with and without contrast.


Discussion

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Images

Cerebral cavenous malformations (cavernomas) centered in the right globus pallidus and right midbrain (red arrows) with associated T1 and T2 internal hyperintensity (left and middle images) and blooming on susceptibility-weighted imaging (right image). Evolution of parenchymal hematoma T1 and T2 signal over time.



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