44-year-old female with known CCMs and DVAs, prior history of bleeds in 1997, 2008, and 2012. Gamma Knife resection in 2002 of cavernoma. 2008 resection. Second CCM in the left parietal region found in 2012. There is a 7 x 7 mm (series 1301/72) T2 hypointense, central T1 hyperintense and peripherally T1 hypointense lesion in the posterior left middle temporal gyrus, which demonstrates mild-moderate contrast enhancement, consistent with a cavernous venous malformation. There is associated blooming on susceptibility weighted imaging. Adjacent prominent vessel, which extends to the margin of the left lateral ventricle, is consistent with an associated developmental venous anomaly.Focal deformity of the left inferior occipital bone with underlying hemosiderin staining and associated volume loss of the left cerebellar hemisphere, is compatible with prior surgery. There is a resection cavity in the left cerebellum, with associated atrophy of the inferior and middle cerebellar peduncles. There is a prominent associated vessel running posterior and lateral to the resection cavity, which may represent an associated developmental venous abnormality of the resected cavernoma.There is no restricted diffusion seen to suggest acute infarction. There is mild ex vacuo dilatation of the fourth ventricle; but otherwise, the ventricles and basal cisterns are normal. There is no midline shift or herniation. Few scattered punctate T2 hyperintense foci in the subcortical white matter are nonspecific. Intrinsic T1 hyperintensity in the dentate nuclei are seen bilaterally, likely relating to mineralization.
1. Findings compatible with cerebral cavernous venous malformation and developmental venous anomaly in the left posterior temporal lobe.2. Postsurgical changes consistent with reported history of prior cerebral cavernous venous malformation resection in the left cerebellar hemisphere, with possible associated developmental venous anomaly.