CASE 866 Published on 22.02.2001

Cerebellar Hemangioblastoma

Section

Neuroradiology

Case Type

Clinical Cases

Authors

J.C.W. de Jonge, J.T. Wilmink, B.K. Janevski

Patient

55 years, male

Categories
No Area of Interest ; Imaging Technique CT, MR
Clinical History
presented with a 5 month history of headache and nausea without vomiting. Recently he had staggering gait and a tendency to fall. His personal history reveals a hospitalization because of suspected temporal epilepsy sixteen years ago. All examinations at that time, including cerebral angiography and pneumoencephalography, were normal. The present neurological examination was essentially normal, except for mild ataxia. CT scan and MRI of the brain were performed, followed by right vertebral angiography.
Imaging Findings
A 55-year-old man presented with a 5 month history of headache and nausea without vomiting. Recently he had staggering gait and a tendency to fall. His personal history reveals a hospitalization because of suspected temporal epilepsy sixteen years ago. All examinations at that time, including cerebral angiography and pneumoencephalography, were normal. The present neurological examination was essentially normal, except for mild ataxia. CT scan and MRI of the brain were performed, followed by right vertebral angiography. Imaging findings of a sharply delineated cystic tumor with solid hypervascular component were strongly suggestive for hemangioblastoma. At surgery, the tumor was completely removed. Histopathological examination confirmed the diagnosis of cerebellar hemangioblastoma.
Discussion
Hemangioblastomas are common cerebellar neoplasms, accounting for 7-12% of all posterior fossa tumors. They generally occur within the cerebellum, less commonly involve the medulla oblongata or spinal cord and are rarely found supratentorially. Hemangioblastomas usually occur sporadically, but family may be positive in 4-20 % of cases. In patients with a family history of von Hippel-Lindau (VHL) disease, there is a high incidence of multisystemic manifestation. The average age of onset of neurological symptoms in patients with hemangioblastoma is in the middle to late thirties, but patients with family history of VHL disease generally present earlier. This tumor appears twice more often in men than in women. The tumor is easily detectable on CT and MRI examination. On CT scan, the cystic component is generally sharply defined, with an attenuation value equal to, or slightly higher than cerebrospinal fluid. On unenhanced scan, the mural nodule is isodense to brain tissue. After intravenous contrast injection it enhances intensely and uniformly. Because of the high protein content of the cysts, they are slightly hyperintense to CSF on T1-weighted MR images. They generally present without surrounding edema. On angiography hemangioblastomas mostly are highly vascular neoplasms. Sometimes pilocytic astrocytoma and hemangioblastoma are indistinguishable. Simple arachnoid cyst, enlarged fourth ventricle secondary to obstruction of foramina of Magendie and Luschka, and cystic metastasis have to be included in the differential diagnosis.
Differential Diagnosis List
Hemangioblastoma
Final Diagnosis
Hemangioblastoma
Case information
URL: https://eurorad.org/case/866
DOI: 10.1594/EURORAD/CASE.866
ISSN: 1563-4086