Cavernous malformation of the spinal cord | Figure 1

Cavernous malformation of the spinal cord

Sagittal T1 (image 1), coronal T2 (image 2), and axial susceptibility-weighted MRI (image 3) reveal a cavernous malformation (arrow) within the cervical spinal cord. Cavernous malformations are predominantly found in the brain, with spinal cord lesions accounting for approximately 5% of malformations. Spinal cavernous malformations most commonly occur in the thoracic region. Unlike brain lesions, spinal cord cavernous malformations are usually asymptomatic but may present with acute, stepwise neurological decline or a gradual progression of symptoms.

Similar cases

Sagittal T2 MRI of the upper (image 1) and lower (image 2) spine show a large holocord syrinx (arrowhead) caused by a Chiari I malformation (arrow). Chiari I malformation is characterized by inferior migration of the cerebellar tonsils through the foramen magnum. When a Chiari I malformation is present, the cerebellar tonsils can be pointed having a peg shape. A syrinx occurs with greater degrees of compression. Typically, if a syrinx is present, it is small and limited to a short segment of the spinal cord.

Axial T1 FLAIR (image 1), T2 (image 2), FLAIR (image 3), and T1 post-contrast (image 4) MRI show a cavernous malformation (arrow) in the right temporal lobe. The lesion exhibits heterogeneous T1 signal and minimal enhancement, with a characteristic hypointense rim on T2 and FLAIR due to mild hemorrhage. Most patients with a cavernous malformation are asymptomatic but can present with headaches, seizures, or focal deficits if hemorrhage occurs.

Sagittal T2 image in a 9-year old with neck pain and right sided weakness demonstrates a heterogeneous, hemorrhagic lesion in the cervical spinal cord with many areas of hypointense T2 signal, but lacking any large vascular flow voids. Initially concerning for hemorrhage into a tumor, such as an ependymoma or hemangioblastoma, the lesion was resected and found to be a cavernous malformation. These vascular lesions may present acutely, or they may have a more slowly progressive onset with intermittent bleeding. It is important to screen the brain for additional lesions. #NeuroWednesday

Cerebral cavernoma Cavernomas or cavernous malformations of the brain are lesions of the cerebral capillary blood vessels, which, when dilated and irregular, allow blood components to "leak" into neighboring brain tissue. It is a common disease (0.5% of the population) but little known since most carriers are asymptomatic. It is estimated that the reserve of patients with cavernous brain lesions without symptoms is greater than the number already diagnosed. Most symptomatic patients have epilepsy, headache or neurological deficiency, usually due to bleeding from the lesions. Magnetic resonance imaging is the most effective imaging method for detecting and analyzing a cerebral cavernous malformation. Pop-corn imaging is typical, demonstrating a heterogeneous lesion of different intralesional signal intensities, which represent small thrombi within the cavernoma secondary to its low flow, and a halo of hypodensity due to extravasation of blood elements, mainly hemosiderin. In the case above, we have a female patient with sudden headache who underwent brain MRI, where an oval image in the popcorn-shaped left frontal lobe was identified, with hypersignal on its peripheries and central hyposignal on FLAIR sequences. , T2, T1 and hyposignal in the SWI sequence and with post GD contrast reaction in the T1 sequence, compatible with cerebral cavernoma.