Cavernoma presenting with an atypical clinico-radiological finding: A case report

Abstract

Background: Cavernomas (cavernous angiomas, hemangiomas) are benign, clearly defined, vascular hamartomatous lesions composed of vascular channels lined by one layer of endothelium separated by a matrix made of smooth muscles and collagenous tissue. Although the diagnosis of cavernoma is straightforward in a patient presenting with typical findings, lesions with aggressive clinical and atypical radiological features may be misdiagnosed as primary or metastatic brain tumors especially when encountered in an emergency. Case discussion: Herein, we report a case of a 42-year-old lady presenting in the emergency room with a decreased level of consciousness and a heterogenous intra-axial lesion in the left parieto-temporal lobe demonstrating T1 hyperintensity with large perilesional edema and mass effect. The lesion was completely removed along with the hematoma. The patient was diagnosed with giant cavernoma with hemorrhage after obtaining the histopathology report. The patient was asymptomatic at 6 months of follow up and her follow-up CT scan showed complete extirpation of the lesion. Conclusion: Patients with giant cavernoma accompanied by a recent hemorrhage can present with rapid deterioration of consciousness and atypical radiological findings. Such a patient can also demonstrate a T1 hyperintense perilesional signal intensity which can be a useful sign for predicting the cavernoma. Cavernoma should be differentiated from other hemorrhagic cerebral masses when encountered in an emergency.

Keywords

• Cavernous
• Hemangioma
• Hemorrhage
• Tumor