Presentation
Sudden onset headache three days ago followed by unsteadiness during ambulation.
Patient Data
Central pons round lesion with peripheral hyperattenuating (75 HU) content suggestive of hemorrhage, with no overt perilesional edema or hydrocephalus, likely cerebral cavernous venous malformation with recent bleeding.
Ring artefacts are seen in the pre- and post-contrast images.
A well-defined (2.3 cm x 2.1 cm) lesion in the pons with acute hemorrhage demonstrated as high T1 signal intensity and blooming artefact on gradient echo sequence with associated minimal perifocal edema, but no diffusion restriction, or post-contrast enhancement. Minimal hematoma on the floor of the fourth ventricle and effacement of the anterior aspect of the fourth ventricle from mass effect. No associated regional arteriovenous malformation, or focal aneurysm.
Case Discussion
Cerebral cavernous venous malformation is a common intracranial vascular pathology, often found incidentally, and if symptomatic, presents around the fourth to sixth decade of life. Around 80 percent of the cases are supratentorial, and the remainder can be found infratentorial. This young patient came with a few days' history of severe headache and unsteadiness during ambulation, and imaging with CT and MRI demonstrated a cavernous malformation with recent bleeding in the pons.
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