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Hemangioblastoma, case 3

CLINICAL HISTORY:
This 40-year old woman complains of four months of increasing headaches and gait instability with deviation to the right. She noticed decrease of the fine motor function of the fingers and episodes of oscillopsia.

NEUROLOGICAL EXAMINATION reveals gait instability and hypotonia of the left hand.

MRI:
a) TRANSAXIAL T2-WEIGHTED (3800/90/1) SPIN-ECHO SEQUENCE (IMAGE 1): Presence in the left cerebellar hemisphere of an oval space occupying lesion. The mass appears cystic, but is overall more hyperintense than cerebrospinal fluid. At its anterolateral wall a more hypointense nodule (arrowhead) is present. Notice displacement of the fourth ventricle (arrows).

b) TRANSAXIAL T1-WEIGHTED (600/14/1) SPIN-ECHO SEQUENCE (IMAGE 2): The cyst is hypointense. The nodule (arrowhead) again is well-recognized.

c) TRANSAXIAL (IMAGE 3), CORONAL (IMAGE 4) AND SAGITTAL (IMAGES 5 AND 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is no enhancement of the cyst nor of the cyst wall. The lateral nodule (arrowhead) is intensely enhancing and appears to be situated near the pial surface of the cerebellum. Notice again the displacement of the fourth ventricle (arrow).

ANGIOGRAPHY: selective injection of the right vertebral artery in the anteroposterior (IMAGE 7) and the lateral (IMAGE 8) view: Intense hypervascular appearance of the tumor nodule (arrowhead), with evidence of an early draining vein (arrows).

RADIOLOGICAL DIAGNOSIS is hemangioblastoma based on the cystic nature of the lesion with enhancing mural nodule.

SURGICAL FINDINGS: At surgery, the cyst was found, filled with a yellow clear fluid. At the lateral cyst wall a 1 cm diameter highly vascular mass was seen. Total resection was accomplished.

ANATOMOPATHOLOGY (IMAGE 9) was consistent with hemangioblastoma.

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Fig. 1

Hemangioblastoma, case 3, Fig. 1
Hemangioblastoma, case 3, Fig. 2
Hemangioblastoma, case 3, Fig. 3
Hemangioblastoma, case 3, Fig. 4
Hemangioblastoma, case 3, Fig. 5
Hemangioblastoma, case 3, Fig. 6
Hemangioblastoma, case 3, Fig. 7
Hemangioblastoma, case 3, Fig. 8
Hemangioblastoma, case 3, Fig. 9