Chronic Encapsulated Intracerebral Hematoma Associated with Cavernous Malformation
A 12-year-old female was admitted to our hospital because of a one-week history of progressive headache and nausea. She had no prior history of radiation therapy or surgery. She had a past history of a simple febrile seizure at 21 months of age, and a brain magnetic resonance imaging (MRI) study was performed on a 1.5 tesla device and was judged normal (). On admission, neurological examination showed no abnormality. A brain computed tomography (CT) scan and MRI on a 3 tesla device showed an intracerebral hematoma surrounded by edema in the right frontal lobe (). One week later, her headache and nausea worsened, and a brain CT scan revealed the enlargement of hematoma (). A right frontal craniotomy was performed. The capsule was opened at a depth of 1 cm from the cortex. The cavity was filled with brownish fluid hematoma similar to chronic subdural hematoma. A lobulated mass was also found on the capsule. The capsule, mass, and hematoma were totally removed (). Histological examination confirmed the diagnosis of CM, and also revealed that the capsule consisted of an outer collagenous layer and an inner granulated layer with deposits of hemosiderin, which was compatible with CEIH (). Immunohistochemical analysis revealed increased expression of vascular endothelial growth factor (VEGF) and the VEGF receptor (VEGFR)-1 in the endothelium and fibroblasts in the capsule (). Postoperative cerebral angiography showed no abnormality. The postoperative course was uneventful and the patient was discharged without neurological deficit.