41-year-old female with a history of bilateral cerebral peduncle cavernomas and acute bleed seen on MRI examination at an outside hospital. Ill defined hyperdensities are noted within the cerebral peduncles bilaterally, the left lesion being located nearer to the thalamus. These lesions are in identical location to the cavernomas characterized by MRI in 2004, at which time there was edema and larger size of the left-sided lesions suggestive of recent hemorrhage.There is no visible edema surrounding cerebral peduncle lesions, nor is there mass effect in this location or elsewhere in the brain. Findings are therefore most consistent with chronic cavernomas, and it is doubtful that there has been any recent change. If there is a high degree of concern regarding this finding, MRI could be obtained or the outside MRI could be compared with the prior from 2004. Outside of the cerebral peduncle lesions, the appearance of the brain is normal with preserved gray-white matter differentiation and no additional lesions identified. There is no midline shift or basal cistern effacement. Ventricles and sulci have normal size and configuration. No abnormal fluid collections.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Orbits unremarkable
Ill-defined hyperdense lesions within the cerebral peduncles, corresponding to cavernomas in these locations previously characterized by MRI in 2004. There is interval reduction size of the left sided lesion since 2004, and there is no convincing evidence of edema or mass effect from either of the lesions based on CT. Therefore, it is felt to be unlikely that there has been recent hemorrhage in this location. MRI examination could be considered for further evaluation if there is a high degree of concern regarding change in symptoms or hemorrhage--it can more sensitively detect edema and would allow same modality comparison with prior study. The outside MRI can be compared to the UC prior if it is available.