Answer:
Multiple cavernous angiomas at varying stages of bleed.
Findings:
CT - Multiple tiny hyperdensities reflecting hemorrhages are seen in right temporal, both frontal and left parieto-occipital regions.
MRI - Multifocal areas of T2 hypointensities are seen in right temporal, both frontal and left parieto-occipital regions. These show gradient blooming and appear T1 hyperintense. Few lesions in the left parieto-occipital regions show perilesional edema.
Discussion
Cavernous angioma is benign vascular harmartoma with masses of closely apposed immature blood vessels ("caverns"), intralesional hemorrhages of different ages, no neural tissue.
Zabramski classification of CMs
Type 1 = subacute hemorrhage (hyperintense on Tl WI; hyper- or hypointense on T2WI)
Type 2 = mixed signal intensity on Tl-, T2WI with degrading hemorrhage of various ages (classic"popcorn ball" lesion)
Type 3 = chronic hemorrhage (hypo- to iso on Tl- T2WI)
Type 4 = punctate microhemorrhages ("black dots"), poorly seen except on GRE sequences
Contributed By: Dr.Anbumalar, PGY-3, B.I.R, Chennai, India
Multiple cavernous angiomas at varying stages of bleed.
Findings:
CT - Multiple tiny hyperdensities reflecting hemorrhages are seen in right temporal, both frontal and left parieto-occipital regions.
MRI - Multifocal areas of T2 hypointensities are seen in right temporal, both frontal and left parieto-occipital regions. These show gradient blooming and appear T1 hyperintense. Few lesions in the left parieto-occipital regions show perilesional edema.
Discussion
Cavernous angioma is benign vascular harmartoma with masses of closely apposed immature blood vessels ("caverns"), intralesional hemorrhages of different ages, no neural tissue.
Zabramski classification of CMs
Type 1 = subacute hemorrhage (hyperintense on Tl WI; hyper- or hypointense on T2WI)
Type 2 = mixed signal intensity on Tl-, T2WI with degrading hemorrhage of various ages (classic"popcorn ball" lesion)
Type 3 = chronic hemorrhage (hypo- to iso on Tl- T2WI)
Type 4 = punctate microhemorrhages ("black dots"), poorly seen except on GRE sequences
Contributed By: Dr.Anbumalar, PGY-3, B.I.R, Chennai, India