71/106. Value of gradient-echo magnetic resonance imaging in the diagnosis of familial cerebral cavernous malformation. BACKGROUND: Cerebral cavernous malformations (CCMs) are congenital vascular anomalies that can cause seizures, intracranial hemorrhages, focal neurological deficits, and migrainelike headaches. Magnetic resonance (MR) imaging has substantially facilitated diagnosis of CCM. It is now widely accepted that familial clustering with an autosomal dominant inheritance pattern should be suspected in cases of multiple lesions. OBJECTIVE: To determine by MR imaging the penetrance of cavernous malformations in a 3-generation family that included 5 members with typical clinical signs and diagnostic findings. methods: All family members underwent routine MR T1-weighted and T2-weighted spin-echo sequences in addition to MR T2-weighted gradient-echo sequences. RESULTS: Four family members had been symptomatic with either brainstem bleeding, headaches, or focal neurological signs. The gradient-echo sequences yielded a dramatically higher sensitivity with regard to lesion number and distribution.As in previous reports of familial CCM, an increase in lesion number with increasing age, changes in lesion characteristics, de novo occurrence in serial MR imaging over time, and the phenomenon of anticipation could be confirmed in this family. CONCLUSION: Magnetic resonance gradient-echo sequences should be considered the method of choice for diagnosis of familial CCM. ( info) |
72/106. Intraventricular cavernous hemangioma at the foramen of Monro: Case report and literature review. Cavernous hemangiomas rarely occur in the cerebral ventricles. Those occurring at the foramen of Monro are even less frequent. So far, only eight cases of cavernous hemangioma at the foramen of Monro have been reported in the literature. Here, we present a similar case and correlated the radiographic with the histopathologic findings of the patient. A 51-year-old woman was admitted with obstructive hydrocephalus-related symptoms. The computed tomography (CT) and magnetic resonance imaging (MRI) revealed a partly calcified lesion with slight contrast enhancement located in the area of the right foramen of Monro. The lesion was completely removed by surgical resection with a transfrontal transventricular approach. The resected mass was histologically diagnosed as cavernous hemangioma. The patient's symptoms resolved immediately after operation. Cavernous hemangioma at the foramen of Monro in the present case had common MRI features as previously reported. Although MRI can provide initial diagnosis for such unusually localized tumor, it should be confirmed histopathologically. ( info) |
73/106. Third ventricular cavernous haemangioma. We report a case of a third ventricular cavernous haemangioma (cavernoma). Cavernomas rarely occur within the ventricular system. Only 47 well-documented cases have been reported in the literature, 21 of which were located in the third ventricle. Cavernomas should be considered in the differential diagnosis of third ventricular lesions. Ventriculoscopy is very useful in establishing the diagnosis. ( info) |
74/106. Cavernous malformation after radiation therapy for astrocytoma in adult patients: report of 2 cases. radiation-induced cavernous malformations are rarely reported, and most cases have been children. We describe two adult patients with cavernous malformation after irradiation for astrocytoma. Magnetic resonance (MR) imaging, at their ages of 53 years, showed a cavernous malformation in the irradiated field 26 and 10 years after resection and irradiation, respectively. Cavernous malformations were confirmed by the histopathological examination in the both cases. radiation-induced cavernous malformations are rare in adult patients with astrocytoma. One reason why we found two such cases was that these patients had been successfully treated for astrocytoma and had long follow-up periods. ( info) |
75/106. Unusual locations for cavernous hemangiomas: report of two cases and review of the literature. Cavernous hemangiomas are most commonly found within the subcortical neural parenchyma near the fissura Rolandi, in the basal ganglia, or in the brain stem. Because of advancing neuro-imaging technology and thus resulting in a higher incidence of cavernous hemangiomas they have rising impact in neurosurgery. We present two unusual cases of extra-axial cavernous hemangiomas: one located at the frontal falx, the other within the bone of the right frontal bone. We discuss these and other cases in the literature with respect to the more common differential diagnoses and the appropriate therapy regimen for cavernous hemangiomas in these locations. ( info) |
76/106. Parasagittal hemangioma associates with unilateral cheiro-oral-pedal syndrome. Cortical lesion might elicit restricted acral sensory deficit but a disparity of topographies in cheiro-oral-pedal syndrome is very rare. We report the first case of cheiro-oral-pedal syndrome due to a contralateral parasagittal hemangioma involving the supplement sensory area in parietal lobe. This unusual link between neuroanatomy and neurological feature is discussed. ( info) |
77/106. Spinal intradural-intramedullary cavernous malformation. Case report and literature review. Cavernous angiomas or cavernomas are uncommon vascular malformations of the central nervous system and spinal involvement is much rarer especially in pediatric patients. We report a case of spinal intradural-intramedullary cavernous angioma in a 14-year-old male child. The cavernoma was located at the level of C6-C7 at the dorsal part of the spinal cord. The diagnosis was made with MRI and the patient underwent surgical treatment. The cavernoma was totally removed with laminotomy and microsurgical techniques. Somatosensory evoked potential monitoring was also used peroperatively. The clinical, radiological and surgical features of this rare case were presented and discussed with reference to the literature. ( info) |
78/106. Demonstrated rapid growth of a corpus callosum cavernous angioma within a short period of time. Cavernous angiomas are uncommon central nervous system vascular malformations. They occur in the corpus callosum very rarely. In this study we report a case of corpus callosum cavernous angioma which demonstrated rapid growth within a short period of time. corpus callosum cavernous angiomas have distinct features regarding growth and should be treated more carefully by giving more importance to surgical removal rather than a conservative approach. ( info) |
79/106. Unrecognized intracerebral glass particle mimicking cavernoma: case report. OBJECTIVE AND IMPORTANCE: Although the presence of a foreign body in the cranium after a head injury is a well-known entity, cases of retained intracranial foreign bodies causing a delayed onset of neurological symptoms are rare. To our knowledge, an unrecognized intracerebral glass particle mimicking a cavernoma has not been previously reported in the literature. CLINICAL PRESENTATION: We report a unique case regarding an intracranial foreign body. A 39-year-old patient presented with new-onset epilepsy. The patient had no history of trauma. According to the magnetic resonance imaging findings and the patient's clinical course, the responsible lesion was considered to be a temporal cavernoma. INTERVENTION: During the operation, surprisingly, a glass particle was found within the temporal lobe. The glass had penetrated the cranium during a minor head injury and had remained undetected for 33 years. The patient was seizure-free without medication during 3 years of follow-up. CONCLUSION: Intracranial small foreign bodies can be difficult to diagnose, especially in patients with no history or a vague history of head trauma. patients with long-standing retained foreign bodies may remain clinically well until complications arise. Intracranial foreign bodies may mimic other pathologies clinically and radiologically. ( info) |
80/106. Cavernous malformation within a schwannoma: review of the literature and hypothesis of a common genetic etiology. The finding of cavernous malformations within tumors of the central or peripheral nervous system is a rare occurrence. We report a case of a histologically proven cavernous malformation found within an eighth cranial nerve schwannoma in a 76-year-old man. The patient presented with progressive loss of hearing on the left, facial pain and dysesthesia. Symptoms improved significantly after the tumor was subtotally resected through a left retrosigmoid craniotomy. Including the present report, 34 cases of cavernous malformations associated with tumors of nervous system origin, 24 cases (71%) involving tumors of Schwann cell origin, and 9 cases (26%) involving gliomas have been published. The cases were classified into two forms based on the type of association. Conjoined association, in which the cavernous malformation is located within the tissue of the nervous system tumor, and discrete association, in which the cavernous malformation and nervous system tumor are in separate locations. We explore the etiology of this association and hypothesize that a common genetic pathway may be involved in a majority of these cases. ( info) |