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Basic information
Date of admission: 96.11.06
Gender: female
Age: 36
Present and past history
Chief complaint: general weakness and lethargic about
several weeks
presnet illness and Past history :
1. Seizure history since junior high school f/u in CGMH and
never attack her after senior high school
2. Brain tumor was found by brain MRI 2 years ago and
reported as benign tumor
Present and past history
3. she was presented to our outpatient department for the
second opinion and received R/T with SRT 300 cGy *
10
4. Another Brain MRI was done on 96/09/03 and
showed:1. Multiple cavernous angiomas
5. On 96/11/12, CT sim for boost after evaluation
Present and past history
6. headache,general weakness and lethargic about
several weeks ago
7. Then, admitted after evaluation for R/T
Physical examination
Vital sign: stable, but high BP 153/82
No consciousness change
HEENT: grossly normal
Chest: breathing sound clear, regular heart beat, no
heart murmur
Abdomen: soft, normactive bowel sound
Extremities: ROM intact, no pitting edema
Neurologic examination
Cranial nerve:
1. CN I ~ CN XI intact
2. CN XII showed positive fasciculation
Motor system
1. Normal muscle power and muscle tone
2. DTR of bicepes, tricepes, knee, supinator, and ankle all
normal
Neurologic examination
Sensation: intact light touch, pain, temporature, and joint
position
Coodination：
1. Finger-nose-finger test： no ataxia (+ )
2. Heal-chin test no ataxia (+ )
3. Romberg's test (- )
Laboratory data
WBC
RBC
8740/mm3
3.64 X 106 /mm3
Hb
Hct
PLT
Alb
BUN/Cr
Na/K
Ca:
11.5 g/dl
34.6 %
203 X 103/mm3
3.1g/dl
12/ 0.8
137/4.0
8.3 mg/dl
Image findings
MRI
T1W
MRI T1
MRI T1
MRI-T2W& MRA
Differential diagnosis
Vascular malformation
1. AVM
2. Developmental venous anomaly
3. Cavernous hemagioma
Tumor with bleeding
Impression
Multiple heterogeneously high signal intensity on T1W,
mixed high signal and dark signal rim on T2W
Multiple Subacute intracranial hemorrhage with
hemosiderin rim with focal edema
Obstructive hydrocephalus of 3rd ventricle
Suspected mass effect by hemorrhagic tumor
pathology
cavernous angioma with ectatic vascular channels
containing blood clots and fibrins walled by fibrotic to
scelrotic tissue lacking intervening neural tissue.
The neural tissue at the peripehral area shows focal
calcification and scatterd hemosiderin-laden microglia
Discussion
Clinical presentation
Cerebrum 70%, pons and cerebellum 25%
Mean age: 30~40,
male: female = 1 : 1
Sporadic or familial
location
Symptoms and signs
Supratentorial
1. hemorrhage 5%,
2. seizures 50%,
3. progressive neurologic
deficits 30%.
Infratentorial
1. hemorrhage and progressive
neurologic deficits ,
2. brainstem present with
cranial neuropathies and
long-tract signs
Typical image
CT scan: nonspecific, irregular, hyperdense mass with
variable degrees of calcification
MRI:
1. popcorn" pattern of
variable image
2. dark hemosiderin ring,
best seen on T2
Angiograpy: Blood flow through CMs is minimal. Thus,
they may not be seen on angiography
treatment
Asymptomatic
generally observed carefully,
with follow-up MR imaging
performed at yearly or 2-year
intervals.
Symptomatic (severe headache, should be resected with the aid
seizures, progressive
of frameless stereotactic
neurological deficits)
guidance.
prognosis
more than two-thirds of patients were seizure free at 3
years after surgery
Predictors for good outcome:
1. mesiotemporal location,
2. size <1.5 cm
3. the absence of secondarily generalized seizures.