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Cavernous angioma

 

Clinical history
This 35-year-old female complains of dysesthesia of the left hemi-thorax for as long as five years! Recently, she experienced severe back pain and sudden numbness of the lower right limb.

Neurological examination
Normal motor strength in the four limbs. Hypoesthesia with numbness in the right lower limb.

MRI findings
Image1: SagittalT1WI: a small high signal focus (arrow) is seen at the level of Th 8 surrounded by a more extensive patchy area of low signal intensity.
Image 2: Sagittal T2WI. The most typical MR appearance of a cavernoma is usually found, like in this case, on gradient echo T2 weighted images showing signs of subacute and chronic hemorrhage characterized by mixed high- and low-signal components.
Image 3: Sagittal GdT1WI: mild but definite contrast enhancement is seen within the lesion.
Image 4: Axial T1WI
Image 5: Axial GdT1WI
The axial scans confirm the left anterior location of this small cavernoma as well as the mild contrast uptake within the lesion

As cavernous angiomas may be multiple the entire spinal cord as well as the brain should be examined by MRI. In this case no other lesion was found.
Spinal angiography is typically normal in case of spinal cavernomas. Still, in this patient, angiography was made before surgery in order to identify the origin and course of the artery of Adamkiewicz which originated from the left tenth intercostal artery.

Surgery (March 98)
Total removal of an intramedullary cavernous angioma was achieved by a Th8-Th9 costo-transversal approach and with per-operative monitoring of the somesthesic evoked potentials. This cavernoma was typically a well circumscribed, reddish-brown mass that could easily be removed as it was well encapsulated, located close to the surface of the cord as shown on the axial MR images.

Histology
Cavernous angioma

Clinical follow-up
Post operative clinical examination shows no changes in the neurological status: the patient walks normally and experiences no motor deficits but hyperesthesia of the right inferior limb remains unchanged.

MRI follow-up
Total removal of the cavernous angioma is confirmed.

Image 6: Sagittal T1WI
Image 7: Sagittal T2WI: hemosiderin deposits are still visible, especially well seen on Gradient echo T2WI.
Image 8: Series of axial T2WI
Image 9: Sagittal Gd T1WI: absence of contrast enhancement
Image 10: Axial Gd T1WI

Comment
Delays in diagnosis are unfortunately rather common like in this case! The thoracic cord is the most common location for cavernous angiomas.
A 2:1 female predominance has been reported in literature.

Search also:
- Cavernoma

 

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Fig. 1

Cavernous angioma, Fig. 1
Cavernous angioma, Fig. 2
Cavernous angioma, Fig. 3
Cavernous angioma, Fig. 4
Cavernous angioma, Fig. 5
Cavernous angioma, Fig. 6
Cavernous angioma, Fig. 7
Cavernous angioma, Fig. 8
Cavernous angioma, Fig. 9
Cavernous angioma, Fig. 10