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35b - Answer: 53-year-old male presents with congenital anomaly of cerebrovascular system

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

HISTORY: 

This 53-year-old male presents with congenital anomaly of cerebrovascular system.

(QUIZ ANSWER) NOT A FINDING: 

Meningeal enhancement with evidence of basilar meningitis.

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

FINDINGS:

1.7 x 1.3 x 1.6cm mulberry-type intraparenchymal midbrain lesion which is slightly asymmetric to the left and extends superiorly into the posterior 3rd ventricle with posterior displacement of the collicular plate. There is mass effect upon the cerebral aqueduct. Peripheral siderosis consistent with remote hemorrhage. Finding was present on prior MRI, but may be slightly larger.

In comparison to the earlier examination, lateral 3rd ventricles and temporal horns are more prominent consistent with obstructive hydrocephalus. 

Calvarium is intact. 

Craniocervical junction is without Chiari malformation. 

Left maxillary sinus mucous retention cyst. Masticator, parapharyngeal, pharyngeal mucosal, prevertebral and parotid spaces are without masses or adenopathy. 

Sphenoid sinus mucous retention cyst. 

7th and 8th nerve complexes are intact. Cochleae and vestibula are intact. Otomastoid airspaces are clear. 

Diffusion-weighted images are without a diffusion restrictive defect. 

Periventricular and subcortical hyperintensities may represent gliosis of microangiopathic origin and were present on prior MRI. 

No extraaxial collections or hemorrhage. 

No meningeal enhancement or evidence of basilar meningitis. 

Polar increase in T2 hyperintensity may represent subtle component of ventricular capping secondary to transependymal spread of CSF.

CONCLUSION

1. Central and right midbrain mulberry-type lesion with siderosis consistent with brainstem cavernoma. In comparison to prior MRI, lesion may be very slightly larger in its AP direction. No acute hemorrhage. 

2. Interval enlargement of the ventricular system consistent with obstructive hydrocephalus. 

3. Subcortical hyperintensities may represent gliosis of microangiopathic origin. Findings appear stable in comparison to prior MRI.

LESSON 3, TOPIC 75

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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