|Title : Case 555|
Age / Sex : 35 / M
Chief complaint :
Right sided hypesthesia for several months
Answer: Cavernous malformation
There is a small, poorly marginated intramedullary mass in the left hemicord of T1-2 level. The mass demonstrates bright signal intensity on T1-weighted image, and heterogeneous signal intensity with surrounding dark signal-intensity rim. No contrast enhancement is subtle or absent on post-contrast T1-weighted image.
Spinal cord hemorrhage
Hemorrhagic intramedullary tumors
Cavernous malformations (CMs), once referred to as cavernous angiomas, are angiographically occult vascular lesions, which account up to 15% of all the vascular malformations. The lesions are frequently found in the brain, but can occur throughout the central nervous system (CNS). Pathologically, these lesions are composed of dilated, thin-walled capillaries that have a simple endothelial lining with variably thin fibrous adventitia. Typically, there is no brain parenchyma in between the centrally placed vascular channels.
Spinal CMs are increasingly being diagnosed by MRI in patients with varying spinal cord related symptoms or pain syndromes. Due to space occupying growth and recurrent micro-bleeding in the relatively thin spinal cord, spinal CMs can lead to severe neurological deteriorations unlike their intracranial counterparts. The risk of significant haemorrhage like other vascular malformations is considered to be low due to the low venous pressure.
The imaging findings are identical to the intracranial CMs. The lesion has a popcorn ball–like appearance with multiple high signal intensity foci on T1-weighted images, and a low-signal-intensity rim due to hemosiderin deposition.
|Total applicants||33||Correct answers||21|
|박선영||한림대학교 성심병원, 전문의|
|김성관||인제대학교 부산백병원, 전문의|