PMC5844769_01
These images are from 8 years prior to presentation. (
A
) T1-weighted axial magnetic resonance imaging (MRI) with contrast showing the lateral ventricles normal in size and midline in position. (
B
) T2 fast low angle shot (FLASH) MRI demonstrating a 7 mm cavernous angioma within the upper left corona radiata. Considerable signal hypodensity is observed at the periphery of this lesion consistent with abundant hemosiderin deposition secondary to hemorrhage. (
C
) T2 FLASH MRI demonstrating a 9 mm cavernous angioma within the central portion of the midbrain, immediately anterior to the cerebral aqueduct. Considerably less extensive signal hypointensity is observed at the periphery of the midbrain lesion.
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Interestingly, she had been seen in our department in 2009 for visual changes, where magnetic resonance imaging (MRI) demonstrated the suspected cavernous hemangiomas in the brain stem and left corona radiata, without any imaging evidence of a ventricular lesion ( Fig. 1 ).
Axial computed tomography of the head demonstrating a round homogeneous isodensity within the right lateral ventricle. Hyperdense acute hemorrhage within the ventricular and intraparenchymal spaces was observed.
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Computed tomography imaging of the head demonstrated a well-circumscribed, homogeneous isodensity within and adjacent to the right lateral ventricle with hyperdense acute hemorrhage within the ventricular and intraparenchymal spaces ( Fig. 2 ).
T1-weighted axial magnetic resonance imaging demonstrating a T1 hypointense lesion measuring 4.2 cm craniocaudal, 3.2 cm anteroposteriorly, and 3.2 cm transverse in dimensions.
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MRI demonstrated a mass with 4.2 cm craniocaudal, 3.2 cm anteroposteriorly, and 3.2 cm transverse dimensions that was T1 hypointense, T2 hyperintense, mildly diffusion-restricted, avidly enhancing, and well-circumscribed ( Fig. 3 ).
Histological examination showed a spindle/fibroblastic tumor. Ki67, performed to assess proliferative activity, was < 1%. This was consistent with a grade I meningioma, meningothelial subtype.
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Pathology was consistent with a grade I meningothelial meningioma with a K i -67 index of < 1% ( Fig. 4 ).