A series of 14 representative presentations of cerebral cavernous malformations

Abstract

Purpose: Cerebral cavernous malformations are common central nervous system vascular malformations. They are typically a discrete, well-circumscribed cluster of thin-walled vascular sinusoids with a characteristic “mulberry” or “popcorn” appearance on magnetic resonance imaging and are often surrounded by hemosiderin deposits and gliosis. These malformations can present in a variety of ways. The purpose of this paper is to demonstrate presentations of cavernous malformations through cases with associated imaging. Materials/Methods: 14 cases of cerebral cavernous malformations were retrospectively selected from a single institution from 2009 to 2019. The cases include classically appearing lesions as well as association with developmental venous anomaly and capillary telangiectasia. Results: Variations included are large partially calcified lesions, hemorrhagic lesions, atypically shaped lesions, and lesions lacking the “popcorn” appearance or hemosiderin rim. Also presented is a case with multiple lesions and cases displaying the widespread locations of lesions. Locations include the cerebrum, cerebellar vermis, medulla, periaqueductal midbrain, spinal cord, and extradural intracranial cavernous sinus. Conclusion: These cases and literature review illustrate how cerebral cavernous malformations can present. While often asymptomatic, the lesions can cause hemorrhage, seizures, and neurological deficits. They can present in atypical ways or masquerade as non-vascular lesions making diagnosis a difficult task.

Keywords

• Cavernous malformation
• Cerebrovascular disorder
• Hemorrhage
• Seizure
• Vascular malformation