Presentation
Presented with giddiness and forgetfulness for one week.
Patient Data
A well-defined, non-enhancing heterogenous hyperdense, lobulated intra-axial lesion with speckles of calcifications at the right thalamus extending into the right midbrain. No perilesional edema seen.
Mildly enhancing focal dural thickening at right tentorium cerebelli noted. No other focal enhancing brain parenchymal lesion.
Calcified lesion seen at right anterior falx cerebri, may represent calcified meningioma.
No acute intracranial bleed.
Periventricular hypodensities in keeping with deep white matter ischemia.
Ventricles, basal cisterns and sulci are prominent in keeping with cerebral atrophy.
No midline shift.
There is a heterogeneous lesion in the right thalamus extending to the cerebral peduncle of the right midbrain. It is hyperintense on T1W and T2W/FLAIR images with blooming artifacts on T2 FFE sequence, in keeping with intra- and perilesional hemosiderin deposition. No perilesional edema. There is a prominent vessel seen at the left thalamus with a communicating branch to the lesion eventually draining into the straight sinus. No restricted diffusion on DWI/ADC.
Small extra-axial lesion with blooming artifacts at right falx cerebri likely a small calcified meningioma.
Small T1W hypointense and T2W/FLAIR hyperintense lesion seen at the left corona radiata in keeping with chronic infarcts.
Thin periventricular and foci of deep white matter T2W/FLAIR hyperintensities in keeping small vessel disease (Fazekas 1).
Basal cisterns are not effaced.
No midline shift or hydrocephalus.
Visualized paranasal sinuses and bilateral mastoid air cells are clear.
Case Discussion
Radiological diagnosis in keeping with right thalamus/midbrain cavernoma with developmental venous anomaly, right falx cerebri calcified meningioma and left corona radiata lacunar infarct with small vessel disease.
Patient was referred to neurosurgical team in another hospital for further management.
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