Abstract
Cavernomas are rare cerebrovascular malformations that usually occur in sporadic forms with solitary lesions located most often in the hemispheric white matter, but also in the infratentorial or spinal region. Multiple lesions at different CNS levels are considered a hallmark for the familial form of the disease. The diagnostic modality of choice for cerebral cavernous malformations (CCMs) is magnetic resonance imaging (MRI). We present an intriguing case of a 65-year-old male admitted to our hospital with tetraparesis and cognitive impairment where highly sensitive MRI sequences identified many cerebral cavernous lesions at the supra-, infratentorial and cervical–thoracic spine levels, some of them with recent signs of bleeding in a patient with oral anticoagulant therapy due to atrial fibrillation. The mechanism of cognitive impairment in this patient is most probably the interruption of strategic white matter tracts, as it is known to happen in other subcortical vascular pathologies. MRI can be helpful not only in mapping the anatomical distribution of lesions, but also in weighing the risks and making decisions regarding whether or not to continue oral anticoagulant therapy.
Highlights
magnetic resonance imaging (MRI) apSWI sequence (TE 40.00 ms) showing and supratentorial, bilateral, cavernous malpearance of cerebral cavernous malformations (CCMs) consists of well-circumscribed “popcorn-like” lesions of different sizes with a formations, without recent signs of bleeding
Cavernous malformations are present in 0.3–0.5% of the general populamixed-signal intensity core and a hypointense peripheral rim of hemosiderin conferring a tion, some postmortem studies suggest that this number could be higher, up to 4% [1,5]
They occur in sporadic forms (80%), usually with solitary lesions, but familial cases have been reported
Summary
MRI apSWI sequence (TE 40.00 ms) showing and supratentorial, bilateral, cavernous malpearance of CCMs consists of well-circumscribed “popcorn-like” lesions of different sizes with a formations (lesions in the order of tens), without recent signs of bleeding. MRI mixed-signal intensity core and a hypointense peripheral rim of hemosiderin conferring a “blooming” effect This heterogeneous appearance is due to thelesions presenceof of blood products in various appearance of CCMs consists of [1–3]. Cavernous malformations are present in 0.3–0.5% of the general population, some postmortem studies suggest that this number could be higher, up to 4% [1,5] In most cases, they occur in sporadic forms (80%), usually with solitary lesions, but familial cases have been reported. CCMs (Figure 1), whom we were following for secondary epilepsy with rare seizures with focal onset, impaired awareness, and secondary generalization He used to take carbamazepine, but he had discontinued the treatment for the last three years despite our recommendations. T), the number the dimensions substantially increased almost every location
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