Presentation
Epilepsy for a long time. Follow-up of a known lesion.
Patient Data
Heterogenous huge cortical/subcortical mass in the left sensorimotor area, containing abnormal venous vessels draining to superficial veins, best seen on postcontrast images. Decreased grey/white matter differentiation, cortical swelling, absent subarachnoid spaces.
Minimal contrast enhancement within the lesion representing vessels.
There are marked susceptibility artifacts on T2* images due to hemosiderin deposition, also seen as signal void on perfusion and diffusion-weighted images due to T2 blackout effect. Mild perifocal edema.
The remaining intracranial structures seem normal.
Case Discussion
There were no changes in this left sensorimotor area lesion in terms of size or structure for 5 years at least. Since this cortical hemosiderin containing mass is associated with a low-flow vascular malformation, it can be classified as a mixed vascular malformation - simultaneous cavernous malformation and developmental venous anomaly. Because the mass is localized in a dominant eloquent zone, microsurgical resection is contraindicated.
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