PMC3291704_01
Pre-treatment computerized tomography and magnetic resonance images. Axial computerized tomography (A) shows a large, hemorrhagic lesion, with a hyperdense acutely hemorrhagic nodule, within the right occipital lobe, causing a midline shift and right lateral ventricle compression. Axial (B) and coronal (C) T1-weighted magnetic resonance images after gadolinium injection demonstrate that the lesion comprises an acutely hemorrhagic nodule (arrows), isointense with deoxyhemoglobin, and a larger subacute hematoma (asterisks), which is hyperintense due to methemoglobin. An axial T2-weighted image (D) reveals the classic "popcorn ball" configuration of a cavernous malformation (arrow) at the hematoma's posterior margin.
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F1
Cranial computerized tomography (CT) revealed a well-circumscribed, 5.5 cm-diameter mass in the right occipital region, causing a midline shift and right lateral ventricle compression (Fig. 1A). Magnetic resonance imaging (MRI) confirmed that the lesion comprised an acutely hemorrhagic nodule, isointense with deoxyhemoglobin, and a larger subacute hematoma, which was hyperintense due to the presence of methemoglobin (inferred because it was hyperintense on T1-weighted but hypointense on T2-weighted images; Fig. 1B, C). A T2-weighted MRI revealed the classic "popcorn ball" configuration of cavernous malformations at the hematoma's posterior margin (Fig. 1D).
Low power photomicrograph shows a lesion consisting of randomly distributed telangiectatic and congested vascular channels in a stroma, with little intervening neural tissue. The vessels are separated by fibrotic tissue containing hemosiderin deposition (H&E stain, x100).
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F2
Our pathological findings were consistent with a cerebral cavernous malformation (Fig. 2).
Follow-up computerized tomography performed nine days after surgery, showing no space-occupying lesion and no pathological densities.
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F3
A final CT scan at the end of her hospitalization revealed no residual mass (Fig. 3).