Cerebral Cavernous Malformation (Cavernoma)
Last Updated: October 1, 2018
- Benign vascular lesion with a classic imaging appearance
- Blood cavities surrounded by a single layer of endothelium without muscular tissue or intervening brain parenchyma
- Two types:
- Sporadic and familial
- Seizure, hemorrhage, focal progressive neurologic deficits, and headaches
- ~25% are asymptomatic
- Peak presentation in middle age
- Familial cavernous malformations tend to present earlier
- No gender predilection
- Developmental venous anomaly (DVA)
- Superficial siderosis (hemosiderin deposition on the surface of the brain)
- Cutaneous abnormalities
- Café au lait spots
- Hyperkeratotic capillary-venous malformation
- Classic “popcorn ball” appearance with complete hypointense rim on T2
- Often negative
- If positive, will see a well-defined hyperdense lesion with associated calcifications that demonstrates little to no enhancement
- T1WI and T2WI
- “popcorn ball” appearance with low signal rim and mixed internal signal demonstrating differing stages of hemorrhage
- Surrounding edema only present if recent hemorrhage has occurred
- Hypointense signal associated due to hemosiderin and calcification
- Minimal or no contrast enhancement, unless associated with a developmental venous anomaly
- T1WI and T2WI
- Usually normal
- Occasional slow intralesional flow without AV shunting and venous pooling
- MR with contrast
- Contrast used to exclude associated anomalies
- T2*/SWI/GRE sequence with long TE
- When recently hemorrhagic, it can be difficult to distinguish from an underlying hemorrhagic neoplasm or an AVM. Followup imaging is often a necessary approach to monitor the evolution of the blood products and to evaluate for an underlying neoplasm.
Contributor: Sean Dodson, MD
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Moore SA, et al. Long-term natural history of incidentally discovered cavernous malformations in a single-center cohort. J Neurosurg. 2014; 120(5):1188-92.
Sohn CH, et al. Characteristic MR Imaging Findings of Cavernous Hemangiomas in the Cavernous Sinus. AJNR. 2003; 24:1148-51.
Tamburrini G, et al. Large cerebral cavernoma mimicking a brain tumor. Pediatr Neurosurg. 2002; 37(2):105-6.
Yun TJ, et al. A T1 Hyperintense Perilesional Signal Aids in the Differentiation of a Cavernous Angioma from Other Hemorrhagic Masses. AJNR. 2008; 29:494-500.
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