Intraventricular Cavernous Angioma (IVCA)

Peter G. Michaelson, MD; W. Lee Warren, Jr., MD; David R. DeLone, MD; Matthew R. Quigley, MD

Disclosures

December 23, 2004

Abstract and Case Summary

A 22-year-old white woman presented with a 2-month history of ataxia and personality changes, consisting mainly of abulia, headache, and neck pain. Her medical history included significant hypertension and long-standing mental retardation. The physical examination was significant for severely diminished visual acuity in her right eye as well as bilateral papilledema.

A 22-year-old white woman presented with a 2-month history of ataxia and personality changes, consisting mainly of abulia, headache, and neck pain. Her medical history included significant hypertension and long-standing mental retardation. The physical examination was significant for severely diminished visual acuity in her right eye as well as bilateral papilledema.

Contrast-enhanced computed tomography (CT) revealed a complex solid/cystic mass (Figure 1). Magnetic resonance imaging was performed to obtain further information (Figure 2).

Contrast-enhanced CT. A complex solid/ cystic mass is present with extension into the third ventricle. Cyst wall calcification is present (black arrowhead). The solid components enhance with iodinated contrast.

(A) Sagittal T1-weighted MRI (repetition time [TR] 450, echo time [TE] 14, number of excitations [Aeq] 1) shows the mass extending into the ventricular system and inferiorly through the tentorial hiatus. The vermis and 4th ventricle are effaced. Tonsillar herniation is present. The regions of T1-shortening are consistent with methemoglobin. (B) Axial T1-weighted MRI (TR 690, TE 14, Aeq 2) shows the mass extending from an intraparenchymal location into the lateral ventricle. (C) Axial T2-weighted MRI (TR 750, TE 15, Aeq 2) shows (in conjunction with CT, not shown) peripheral hemosiderin deposition (black arrows), compatible with the diagnosis of cavernous angioma. Fluid-fluid levels indicate recent intralesional hemorrhage (black double arrowhead). (D) Axial post-gadolinium T1-weighted MRI (TR 950, TE 17, Aeq 2) shows enhancement of the central nonhemorrhagic components depicted in Figure 2B.

(A) Sagittal T1-weighted MRI (repetition time [TR] 450, echo time [TE] 14, number of excitations [Aeq] 1) shows the mass extending into the ventricular system and inferiorly through the tentorial hiatus. The vermis and 4th ventricle are effaced. Tonsillar herniation is present. The regions of T1-shortening are consistent with methemoglobin. (B) Axial T1-weighted MRI (TR 690, TE 14, Aeq 2) shows the mass extending from an intraparenchymal location into the lateral ventricle. (C) Axial T2-weighted MRI (TR 750, TE 15, Aeq 2) shows (in conjunction with CT, not shown) peripheral hemosiderin deposition (black arrows), compatible with the diagnosis of cavernous angioma. Fluid-fluid levels indicate recent intralesional hemorrhage (black double arrowhead). (D) Axial post-gadolinium T1-weighted MRI (TR 950, TE 17, Aeq 2) shows enhancement of the central nonhemorrhagic components depicted in Figure 2B.

(A) Sagittal T1-weighted MRI (repetition time [TR] 450, echo time [TE] 14, number of excitations [Aeq] 1) shows the mass extending into the ventricular system and inferiorly through the tentorial hiatus. The vermis and 4th ventricle are effaced. Tonsillar herniation is present. The regions of T1-shortening are consistent with methemoglobin. (B) Axial T1-weighted MRI (TR 690, TE 14, Aeq 2) shows the mass extending from an intraparenchymal location into the lateral ventricle. (C) Axial T2-weighted MRI (TR 750, TE 15, Aeq 2) shows (in conjunction with CT, not shown) peripheral hemosiderin deposition (black arrows), compatible with the diagnosis of cavernous angioma. Fluid-fluid levels indicate recent intralesional hemorrhage (black double arrowhead). (D) Axial post-gadolinium T1-weighted MRI (TR 950, TE 17, Aeq 2) shows enhancement of the central nonhemorrhagic components depicted in Figure 2B.

(A) Sagittal T1-weighted MRI (repetition time [TR] 450, echo time [TE] 14, number of excitations [Aeq] 1) shows the mass extending into the ventricular system and inferiorly through the tentorial hiatus. The vermis and 4th ventricle are effaced. Tonsillar herniation is present. The regions of T1-shortening are consistent with methemoglobin. (B) Axial T1-weighted MRI (TR 690, TE 14, Aeq 2) shows the mass extending from an intraparenchymal location into the lateral ventricle. (C) Axial T2-weighted MRI (TR 750, TE 15, Aeq 2) shows (in conjunction with CT, not shown) peripheral hemosiderin deposition (black arrows), compatible with the diagnosis of cavernous angioma. Fluid-fluid levels indicate recent intralesional hemorrhage (black double arrowhead). (D) Axial post-gadolinium T1-weighted MRI (TR 950, TE 17, Aeq 2) shows enhancement of the central nonhemorrhagic components depicted in Figure 2B.

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