Exophytic hypothalamic cavernous malformation mimicking an extra-axial suprasellar mass

Area of Science:

• Neurology
• Neuroradiology
• Neuroscience

Background:

• Cavernomas are rare vascular malformations of the central nervous system.
• They can present with seizures, hemorrhage, or focal neurological deficits.
• Suprasellar and hypothalamic cavernomas are particularly rare and can mimic other pathologies.

Observation:

• A 31-year-old male presented with retro-orbital headache, ptosis, and memory dysfunction.
• Initial CT showed a suprasellar mass, with differential diagnoses including aneurysm, craniopharyngioma, germinoma, or glioma.
• A second intra-axial lesion was noted, raising suspicion for multiple cavernomas or metastatic disease.

Findings:

• CT angiography confirmed normal intracranial vasculature.
• MRI revealed an acutely hemorrhagic hypothalamic and tuber cinereum mass with secondary hemorrhagic foci.
• Diagnosis of multiple cavernomas was confirmed based on imaging characteristics.

Implications:

• This case highlights the importance of considering cavernomas in the differential diagnosis of suprasellar and hypothalamic lesions.
• Accurate diagnosis is crucial for appropriate management and patient counseling.
• Further research into the presentation and management of multiple cavernomas is warranted.