13-year-old female with cerebral cavernous malformation experiencing headache Redemonstrated is a 11 x 11 mm lobulated T2 hyperintense lesion with rim of susceptibility involving the inferior left cerebellar hemisphere abutting the inferior cerebellar vermis measuring 14 x 12 mm in axial plane (previously 11 x 11 mm). There are internal lesional signal changes including new T1 hyperintensity inferiorly as well as 2 foci with a distinctive heme-fluid layering appearance. There is also a tiny amount of new perilesional vasogenic edema. As before, this is associated with a prominent developmental venous anomaly.The remainder of the brain demonstrates no additional cavernous malformations, or other mass or mass effect. There is mild hypoplasia involving the inferior cerebellar vermis. Brain parenchyma is otherwise unremarkable for age. Bilateral hippocampi are unremarkable. No findings to suggest cortical dysplasia or heterotopic gray matter. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are within normal limits. The paranasal sinuses and mastoid air cells are clear.
Slightly enlarged left inferior cerebellar cavernous malformation with adjacent developmental venous anomaly. Internal signal changes as well as a tiny amount of perilesional edema suggest interval new hemorrhage.