Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 4, 2016
Intramedullary Cavernoma
- Background:
- Uncommon intramedullary vascular malformation
- Clinical Presentation:
- Acute onset of neurologic compromise or slowly progressive neurologic decline. Acute neurologic compromise is due to hemorrhage into the spinal cord.
- Key Diagnostic Features:
- Heterogeneous mixed signal intensity on T2WI with hypointense haemosiderin rim and blooming on gradient echo sequence. There is no contrast enhancement.
- Differential Diagnosis:
- Spinal ependymomas: Has a solid component with avid enhancement. Associated with perilesional edema. May show scalloping of the posterior wall of the vertebral bodies
- Astrocytomas: More common in children. Avid enhancement, perilesional edema. Hemorrhage is rare.
- Spinal arteriovenous malformation: Multiple flow voids, enlarged perimedullary-draining veins. Presents with hematomyelia when ruptured. No low-T2 capsule.
- Treatment:
- Microsurgical resection if there are repeated hemorrhages, to prevent further neurological deterioration
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