Calcified brainstem cavernoma in a patient with hundreds of intracranial cavernomas

Unexpected identification of hundreds of lesions on intracranial imaging can be a disconcerting discovery, but familiarity with the possible etiologies of such a finding may help guide further evaluation. We present a case report and literature review of multiple intracranial cavernous hemangiomas.

A 67-year-old non-Hispanic white man developed the sudden onset of painless right-sided hearing loss in August 2006. Magnetic resonance imaging (MRI) of the brain revealed a lesion in the left lateral pontomesencephalic junction with mixed T1-weighted and decreased T2-weighted signal without mass effect or contrast enhancement. There were numerous additional lesions with low T2 signal involving both the cerebellum and the bilateral cerebral hemispheres. In January 2008, further imaging studies, including gradient-echo MRI, were obtained to assess for additional interval changes in the appearance of the intracranial lesions. Results of the patient's current and previous studies were considered most consistent with a clinical and imaging diagnosis of multiple cavernous hemangiomas.

For patients with numerous intracranial lesions, such as those found in cases of multiple cavernous hemangiomas, the use of susceptibility-weighted or gradient-echo MRI can be useful for arriving at an appropriate differential diagnosis and to help guide proper management.