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[Multiple cavernous angiomas accompanied with a convexity meningioma: a case report]
1Department of Neurosurgery, Osaka Medical College, Takatsuki Osaka Japan.
No Shinkei Geka. Neurological Surgery
|November 1, 1994
Summary
This case report details a rare instance of multiple cavernous angiomas co-occurring with a convexity meningioma. Advanced MRI revealed radiation necrosis and cavernous angiomas, missed by CT scans, highlighting imaging modality importance.
Area of Science:
- Neuro-oncology
- Neuroradiology
- Neuropathology
Background:
- Meningiomas are common primary brain tumors, typically benign, but can exhibit malignant features requiring multimodal treatment.
- Cavernous angiomas are vascular malformations that can present with hemorrhage or seizures.
- The co-occurrence of meningioma and multiple cavernous angiomas is exceedingly rare.
Observation:
- A 41-year-old female presented with seizures, initially diagnosed with an anaplastic meningioma treated with surgery and radiation therapy.
- Post-radiation, the patient developed intracerebral hemorrhage and neurological deficits, with MRI revealing multiple lesions suggestive of cavernous angiomas and radiation necrosis.
- Subsequent neurological events were associated with lesions exhibiting characteristic MRI findings of cavernous angiomas, including ring formations.
Findings:
- Computed tomography (CT) initially identified the meningioma but failed to detect the multiple cavernous angiomas.
- Magnetic resonance imaging (MRI) proved superior in characterizing the cavernous angiomas, showing characteristic "ring formations" or "reticulated cores with black rims" on T1 and T2-weighted images.
- Histopathological examination confirmed radiation necrosis as a complication, but the underlying cavernous angiomas were identified through advanced imaging.
Implications:
- This case underscores the diagnostic limitations of CT in identifying multiple cavernous angiomas, especially in the context of post-radiation changes.
- Advanced MRI techniques are crucial for accurate diagnosis and differentiation of vascular malformations from radiation-induced changes in patients with a history of brain tumors.
- The findings highlight the importance of considering cavernous angiomas in the differential diagnosis of new neurological deficits following radiation therapy for brain tumors.