Male, 62 years old, with CCM3 mutation, known acoustic neuroma, yearly follow-up examination. Innumerable susceptibility inducing lesions are redemonstrated scattered throughout both cerebral hemispheres, the brainstem and cerebellum. Since the prior examination, at least three new foci are identified, two in the left centrum semiovale and one in the left aspect of the pons. There may also be several additional new punctate foci but accurate comparison is limited by the small size of these lesions.Of those lesions identifiable on T1-weighted imaging, none shows any evidence of increasing T1 hyperintensity to suggest interval bleeding. In addition, none of these lesions induces any significant local mass effect.An extra-axial enhancing lesion based along the left aspect of the anterior interhemispheric falx is unchanged over multiple prior exams. No new enhancing lesions are appreciated. No significant generalized mass effect is seen. No abnormal extra-axial collections are detected. The ventricles remain normal in size and morphology.On thin section T2-weighted imaging of the IACs, a small nodule of soft tissue thickening is redemonstrated within the right IAC. This lesion no longer enhances as it did and may even be somewhat smaller when compared to earlier examinations. No new IAC or CP angle lesions are identified. The visualized cisternal cranial nerves are otherwise unremarkable.
1.Innumerable lesions are redemonstrated compatible with multiple cavernous malformations. Although there is evidence for at least three new lesions, the bulk of the disease is unchanged and there are no findings to suggest significant interval bleeding.2.A presumed parafalcine meningioma shows no evidence of interval growth.3.A presumed right vestibular schwannoma shows no evidence of interval growth.