Clinical History
Acute headache and vomiting. Four months before, several episodes of seizures and dysarthria. Clinical examination showed right lateral homonymous hemianopsia and right hemiparesia. EEG evidenced dysrythmias of the left hemisphere.
Imaging Findings
The patient was admitted with acute headache and vomiting. Four months before, she had several episodes of seizures and dysarthria. Clinical examination showed right lateral homonymous hemianopsia and right hemiparesia. EEG evidenced dysrythmias of the left hemisphere. CT scan and MRI of the brain were performed.
Discussion
Cavernous malformation (cavernoma) of the brain may exhibit a pseudotumoral behaviour by formation of hematoma. This vascular malformation differs completely from the cavernous hemangioma, which is a real tumor, occurring occasionally in the CNS and nosologically close to the lingual or orbital hemangiomas.
Cavernous malformation, angiographically occult, is particularly well demonstrated by MRI, because of its high specificity for the detection of degradation products of hemoglobin. The MRI presentation is pathognomonic. Macroscopically, cavernous malformation is composed of a cluster of dilated vessels without interposed glial or nervous tissue. The rupture of the wall of these vascular cavities can be at the origin of hemorrhage.
According to Simard, almost all patients with cavernous malformation show gross or microscopical evidence of repeated hemorrhage.
Although usually hematomas occur inside the malformation, in this case the malformation gave rise to a large hematoma located outside the lesion responsible for the onset of symptoms.
Differential Diagnosis List
Intracranial Cavernous Angioma
Final Diagnosis
Intracranial Cavernous Angioma
