Clinical question: Status post cavernoma bleed. Signs and symptoms: Cavernoma. Pre-and post-enhanced brain MRI:Diffusion-weighted images are negative.There is a focus of susceptibility indeed a right centrum semi-ovale with minimal blooming. On T2 weighted images the lesion has characteristic appearance of a cavernous malformation with a rim and internal septations of T2 hypointensity and loculated internal T2 hyperintensity as well as mild surrounding hemosiderin staining parenchyma. There is no evidence of surrounding edema or convincing evidence of hemorrhage. This mass abuts the ventricular wall. This lesion measures approximately 10 x 6.5-mm in transaxial dimensions.On susceptibility MRI series # 901 images 66 through 73 there is suggestion of an additional small cavernoma in the anterior tip of the left temporal lobe measuring at 6-mm in transaxial dimensions. This finding cannot be confirmed with certainty on any of the other MRI sequences.Flair and T2-weighted images demonstrate few tiny foci of hyperintensity in the subcortical and periventricular white matter, a single focus in the posterior limb of left internal capsule and left pos. Although nonspecific this appearance in proper clinical setting could represent chronic small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Post-enhanced images demonstrate no evidence of abnormal enhancement and including the right hemispheric cavernoma. Signal void of major intracranial arterial branches are identified.
1.Negative diffusion weighted images.2.A right centrum semi-ovale cavernoma measuring at 10 x 6.5-mm without evidence of hemorrhage or surrounding edema.3.A second 6mm cavernoma suspected in the anterior left temporal lobe on susceptibility MR images as detailed.4.Few punctate foci of flair hyperintensity in subcortical/periventricular white matter, posterior limb of left internal capsule and left paramedian pons which could represent minimal chronic small vessel ischemic strokes in proper clinical setting.