INCIDENTAL CAVERNOUS ANGİOMA

Öz

Introduction: Besides developmental venous anomaly (DVA), arteriovenous malformation (AVM) and capillary telangiectasia, cavernomas are one of the vascular malformations of the central nervous system. In this case report, we present a case diagnosed with cavernous angioma in the left posterior frontal region, who presented to our emergency department with the complaint of numbness in her left hand. Case: A 38-year-old male patient was admitted to the emergency department with complaints of numbness in his left hand in the last few days. Brain CT examination showed a left sided hyperdensity at the level of vertex, which was suspected of hemorrhage. Afterwards, unenhanced and contrast-enhanced MRI scans of the brain revealed an image, which was considered primarily as hemorrhagic cavernous angioma, showed minimally heterogeneous intravenous contrast enhancement, hyperintense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and measured approximately 11 mm in size in the left posterior frontal region at high ventricular level. The patient was consulted to neurology and neurosurgery departments, and was hospitalized in the neurosurgery service. Discussion: Cavernomas are the third most common vascular malformations after developmental venous anomaly and capillary telangiectasias, accounting for 5-13% of all cerebral vascular malformations. Cavernous angiomas can be seen in any area of the central nervous system (CNS), mostly in cerebral hemispheres (80%). They are most commonly located in the subcortical region and frontal-temporal lobes in the cerebral parenchyma. The most common clinical symptoms include epileptic seizures, intracerebral hemorrhage, focal neurological symptoms and headache. Magnetic resonance imaging is the most sensitive radiological diagnostic method for cavernous angiomas. Asymptomatic cases of cavernous angiomas are followed by periodic MRI studies, surgical resection of the lesions is recommended because recurrent hemorrhages may cause permanent neurological deficits in symptomatic patients. Conclusion: In conclusion, patients with cavernoma present with atypical complaints to the emergency department and can be diagnosed incidentally. Cavernomas are lesions of vascular origin, which tends to be located more frequently in the frontotemporal lobes and subcortical areas, is often accompanied by developmental venous anomalies, and has a radiological appearance that varies according to the extent of hemorrhage.

Anahtar Kelimeler

• Numbness in the left arm,intracranial mass

Kaynakça

1. 1- Cortés Vela JJ, Concepción Aramendía L, Ballenilla Marco F, Gallego León JI, González-Spínola San Gil J. Cerebral cavernous malformations: spectrum of neuroradiological findings. Radiologia 2012;54(5):401–9.
2. 2- de Champfleur NM, Langlois C, Ankenbrandt WJ, et al. Magnetic resonance imaging evaluation of cerebral cavernous malformations with susceptibility-weighted imaging. Neurosurgery 2011;68(3):641–7.
3. 3- Hegde AN, Mohan S, Lim CC. CNS cavernous haemangioma: “popcorn” in the brain and spinal cord. Clin Radiol 2012;67(4):380–8.
4. 4- AG Osborn (Editor). Osborns Brain: imaging, patology, and anatomy. 1st Edition Amirsys: Canada 2013:159–62.
5. 5- Smith ER, Scott RM. Cavernous malformations. Neurosurg Clin N Am 2010;21(3):483–90.
6. 6- Scott RM, Barnes P, Kupsky W, Adelman LS: Cavernous angiomatosis of the central nervous system in children. J Neurosurg 76(1): 38-46, 1992.
7. 7- Osborn AG, Blaser SI, Salzman KL: Diagnostic lmaging Brain. Manitoba, Friesens. 2004; 8:25-28.
8. 8- Anne GO: Brain: Imaging, patology, and anatomy. Osborn AG (ed). Osborns Brain: Imaging, Patology, and Anatomy. 1st ed. Amirsys, 2013:159–162.

9. 9- Smith ER, Scott RM: Cavernous malformations. Neurosurg Clin N Am 21(3):483–490, 2010.
10. 10- Zimmerman RS, Spetzler RF, Lee KS, Zabramski JM, Hargraves RW: Cavernous malformations of the brain stem. J Neurosurg 75: 32-39, 1991.
11. 11- Wilms G, Demaerel P, Bosmans H, Marchal G: MRI of non-ischemic vascular disease: Aneurysms and vascular malformations. Eur Radiol 6:1055-1060, 1999