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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May 28, 2015
Intracranial Cystic Cavernous Malformations
- Background: Intracranial cavernous malformations (CM) are benign vascular hamartomas consisting of irregular dilated vascular channels. Cystic cavernous malformations of the brain are relatively uncommon with only a few cases previously reported in the literature.
- Clinical Presentation: Like many intracranial lesions, the presenting symptoms of cystic CMs are often related to their location. Common presenting symptoms include headache (32%), cerebellar signs (32%), papilledema (24%), hemiparesis (20%), and seizure (20%).
- Key Diagnostic Features: Cystic CMs have an inconsistent radiographic appearance, which can be attributed to the progression through different stages of cystic degeneration or the degree of thrombosis.
- On CT, CMs appear as a heterogeneous cystic lesion with a hyperdense solid component
- On MRI, the ordinary findings include a mixed intensity nodule on T1- and T2-weighted images. The cysts often appear iso- to high-intensity on T1-weighted images, and hyperintense on T2-weighted images.
- Because of their inconsistent radiographic appearance, surgery is often necessary to provide a histopathological specimen for definitive diagnosis.
- DDx:
- Oligodendroglioma
- Cystic meningioma
- Metastasis
- Hemangioblastoma
- Parasitic cyst
- Treatment: Surgery is the optimal management for symptomatic cystic CMs. Considering the outcome, total removal of the nodule with partial resection of the cyst is considered the preferred strategy to avoid significant morbidity.
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