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Case Challenge: Brain MRI Cases


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28b - Answer: 29-year-old female presents with headaches

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files


This 29-year-old female presents with headaches, history of cerebral hemorrhage and question of aneurysm.


Infratentorial siderotic lesions.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


Calvarium is intact. 

No Chiari malformation. 

No suprasellar masses. 

No orbital or retroorbital masses. 

Temporomandibular joints are symmetric. 

Left-sided mesial temporal mulberry-type lesion with chronic blood products measures 1.7cm.

Right frontal mulberry-type lesion with chronic blood products and siderosis measures 1.9cm. Siderotic lesion within the left cerebellopontine angle just lateral to the 7th and 8th nerve entry zones measures 7mm. 6mm hyperintensity within the pons with siderosis. 

3mm lesion left posterior sylvian. 

2mm lesion right superior semilunar lobe of the cerebellum. 

4mm lesion infer surface of the right midtemporal lobe. 

Two 5mm lesions left anterior inferior temporal. 

No obstructive hydrocephalus. 

Diffusion-weighted images are without a diffusion-restrictive defect. 

No extraaxial collections or hemorrhage. 

Nigral and pallidal iron stores are maintained. 

Masticator, parapharyngeal, pharyngeal mucosal, prevertebral and parotid spaces are without masses or adenopathy. 

Carotid and basilar artery flow voids are intact. 

No internal auditory canal or cerebellopontine angle masses. 

Mild otomastoid airspace disease. 

Maxillary and ethmoid sinus mucosal thickening. 

Venous sinuses are patent. 

No orbital masses. No evidence of retinal angioma. 


1. Multiple supra- and infratentorial siderotic lesions consistent with cavernous malformations. Lesions in right frontal, left mesial temporal and left CP angle demonstrate signal characteristics consistent with chronic hemorrhage. Findings may be relevant to provided history of headaches. No evidence of aneurysm. Screening for Osler-Weber-Rendu and hereditary hemorrhagic telangiectasia including nasal exam and chest CT is recommended.

2. Venous sinuses are patent. 

3. No acute cerebral contusion or extraaxial hemorrhage.


Case Challenge: Brain MRI Cases

Case Challenge

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last updated: 2019-10-21 13:17:37

created: 2019-10-21 13:17:37

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