Histology

Histopathology confirmed the imaging diagnosis of a giant cavernoma.

Discussion

• giant cavernomas are rare. In the setting of acute intralesional hemorrhage, atypical imaging features like vasogenic edema, mass effect, loss of peripheral hemosiderin rim, fluid-fluid levels or perilesional hemorrhage may be seen ¹. Angiography is warranted in such cases. Follow up imaging is recommended if the lesion is not surgically treated ^1,2.
• MRI is the investigation of choice. DTI and fMRI are useful in surgical planning and intra-operative neuronavigation when the lesion is seated close to the eloquent areas ³.
• associated developmental venous anomaly (DVA) should be looked for in all cases of cavernoma, as they are often seen together and the presence of a DVA increases the chances of intralesional hemorrhage ⁴.

Corr. Author of the case : Dr. Ullas V Acharya.