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MRI Diagnosis of Brainstem Cavernous Angiomas Presenting as Tumours

Published online by Cambridge University Press:  18 September 2015

Mark C. Preul ,
Jean-Guy Villemure ,
Richard Leblanc  and
Raquel del Carpio-O’Donovan
Mark C. Preul
Affiliation:
Divisions of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal
Jean-Guy Villemure*
Affiliation:
Divisions of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal
Richard Leblanc
Affiliation:
Divisions of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal
Raquel del Carpio-O’Donovan
Affiliation:
Divisions of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University, Montreal
*
Division of Neurosurgery, Montreal Neurological Institute and Hospital, 3801 University St., Montreal, Quebec, Canada H3A 2B4
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Abstract:

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We report experience with 11 patients misdiagnosed for years, on the basis of computed tomography (CT) and angiography, as harbouring brainstem tumours in whom magnetic resonance imaging (MRI) demonstrated cavernous angiomas. Seven had undergone external irradiation, 2 had a ventriculo-peritoneal shunt, 2 developed aseptic femur necrosis following corticosteroid treatment, 1 had undergone a biopsy with a pathological diagnosis of glioma. CT had depicted ill-defined, hyperdense, faintly enhancing lesions. Angiography was normal, or showed an avascular mass or subtle venous pooling. MRI delineated discrete lesions, typical of cavernous angiomas, with a mixed hyperintense, reticulated, central core surrounded by a hypointense rim. Six patients subsequently underwent stereotactic radiosurgery without changes in clinical status or lesion. Although hemorrhagic neoplasms may mimic the clinical course and MRI appearance of cavernous angiomas, MRI is useful in the diagnosis of brainstem cavernous angiomas and should be performed in patients with suspected brainstem tumours.

Type
Articles
Information
Canadian Journal of Neurological Sciences , Volume 19 , Issue 3 , August 1992 , pp. 376 - 382
Copyright
Copyright © Canadian Neurological Sciences Federation 1992

References

1.Abroms, IF, Yessayan, L, Shillito, J, Barlow, CE.Spontaneous intracerebral hemorrhage in patients suspected of multiple sclerosis. J Neurol Neurosurg Psychiatry 1971; 34: 157–162.CrossRefGoogle ScholarPubMed
2.Albright, AL, Byrd, RP, Harrison, ML.Angiographically cryptic AVM presenting as a pontine tumor. Case report. J Neurosurgery 1980; 53: 846–848.Google ScholarPubMed
3.Arseni, C, Stanciu, M.Primary haematomas of the brainstem. Acta Neurochir 1973; 28: 323–330.CrossRefGoogle Scholar
4.Britt, RH, Connor, WS, Enzman, DR.Occult arteriovenous malformation of the brainstem simulating multiple scerosis. Neurology 1981; 31: 901–903.CrossRefGoogle Scholar
5.DeJong, RN, Hicks, SP.Vascular malformation of the brainstem: report of a case with long duration and fluctuating course. Neurology 1980; 30: 995–997.CrossRefGoogle ScholarPubMed
6.Kushner, MJ, Bressman, SB.The clinical manifestations of pontine hemorrhage. Neurology 1985; 35: 637–643.CrossRefGoogle ScholarPubMed
7.Logue, V, Monckton, G.Posterior fossa angiomas. A clinical presentation of nine cases. Brain 1954; 77: 252–273.CrossRefGoogle ScholarPubMed
8.McFerran, DJ, Marks, PV, Garvan, NJ.Angiographically occult arteriovenous malformations of the brainstem. Surg Neurol 1987; 28: 221–224.CrossRefGoogle ScholarPubMed
9.Scott, BB, Seeger, JF, Schneider, RC.Successful evacuation of a pontine hematoma secondary to rupture of a pathologically diagnosed “cryptic” vascular malformation. Case report. J Neurosurg 1973; 39: 104–108.CrossRefGoogle ScholarPubMed
10.Stahl, SM, Johnson, KP, Malamud, N.The clinical and pathological spectrum of brainstem vascular malformations: long term course simulates multiple sclerosis. Arch Neurol 1980; 37: 25–29.CrossRefGoogle Scholar
11.Farmer, JP, Cosgrove, GR, Villemure, JG, Meagher-Villemure, K, Tampieri, D, et al. Intracerebral cavernous angiomas. Neurology 1988; 38: 1699–1704.CrossRefGoogle ScholarPubMed
12.Teilman, K.Hemangiomas of the pons. Arch Neurol Psychiatry 1953; 69: 208–223.CrossRefGoogle Scholar
13.Vaquero, J, Salazar, J, Martinez, R, Martinez, P, Bravo, G.Cavernomas of the central nervous system: clinical syndromes, CT scan diagnosis, and prognosis after surgical treatment in 25 cases. Acta Neurochir 1987; 85: 29–33.CrossRefGoogle ScholarPubMed
14.Gomorri, JM, Grossman, RI, Goldberg, HI, Mackney, DB, Zimmerman, RA, et al. Occult cerebral vascular malformations: high field MR imaging. Radiology 1986; 158: 707–713.CrossRefGoogle Scholar
15.Griffin, C, De La Paz, R, Enzman, D.Magnetic resonance appearance of slow flow vascular malformations. Neuroradiology 1987; 29: 506–511.CrossRefGoogle ScholarPubMed
16.Lemme-Pleghos, L, Kucharcyk, W, Brant-Zawadzki, M, Uske, A, Edwards, M, et al. MRl of angiographically occult vascular malformations. Am J Neuroradiol 1986; 7: 217–222.Google Scholar
17.New, PFJ, Ojemann, RG, Davis, KR, Rosen, BR, Heros, R, et al. MR and CT of occult vascular malformations of the brain. Am J Neuroradiol 1986; 7: 771–779.Google Scholar
18.Rigamonti, D, Drayer, BP, Johnson, PC, Hadley, MN, Zabramski, J.The MRI appearance of cavernous malformations (angiomas). J Neurosurg 1987; 67: 518–524.CrossRefGoogle ScholarPubMed
19.Sadikot, AF, Olivier, A, Bertrand, G, Podgorsak, E, Souhami, L.Radiosurgical treatment of angiographically occult arteriovenous malformations. J Neurosurgery 1991; 74: 346A.Google Scholar
20.Margolis, G, Odom, GL, Woodhall, , Bloor, BM.The role of small angiomatous malformations in the production of intracerebral hematomas. J Neurosurgery 1951; 8: 564–575.CrossRefGoogle ScholarPubMed
21.Potter, JM.Angiomatous malformations of brain: their nature and prognosis. Hunterian lecture. Ann R Coll Surg, Engl 1955; 16: 227–243.Google Scholar
22.Crawford, JV, Russell, DS.Cryptic arteriovenous and venous hamartomas of brain. J Neurol Neurosurg Psychiatry 1956; 19: 1–11.CrossRefGoogle Scholar
23.McCormick, WF, Hardman, JM, Boulter, TR.Vascular malformations (“angiomas”) of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 1968; 28: 241–251.CrossRefGoogle ScholarPubMed
24.McCormick, WF, Nofziger, JD.“Cryptic” vascular malformations of the central nervous system. J Neurosurg 1966; 24: 865–875.CrossRefGoogle ScholarPubMed
25.Russell, DS, Rubenstein, LJ.Pathology of Tumours of the Nervous System. Baltimore: Williams and Wilkins 1989; 727–765.Google Scholar
26.Krayenbuhl, H.Discussion des angiomes supratentoriels. In: van Bogaert, L and Radermacker, J, eds. First International Congress of Neurological Surgery. Brussels: Acta Medica Belgica 1957; 263–267.Google Scholar
27.Krayenbuhl, H, Siebenmann, R.Small vascular malformations as a cause of primary intracerebral hemorrhage. J Neurosurgery 1954; 22: 7–20.CrossRefGoogle Scholar
28.Edelman, RR, Johnson, K, Buxton, R, Shoukimas, G, Rosen, BR, et al. MR of hemorrhages: a new approach. Am J Neuroradiology 1981; 7: 751–756.Google Scholar
29.Eldridge, SA, del Carpio-O’Donovan, R.Magnetic resonance imaging of occult vascular malformations of the brainstem. Can Assoc Radiol J (in press).Google Scholar
30.Leblanc, R, Ethier, R.The computerized tomographic appearance of angiographically occult malformations of the brain. Can J Neurol Sci 1981; 8: 7–13.CrossRefGoogle ScholarPubMed
31.Leblanc, R, Levesque, M, Comair, Y, Ethier, R.Magnetic resonance imaging of cerebral arteriovenous malformations. J Neuro-surgery 1987; 21: 15–20.Google ScholarPubMed
32.Kashiwagi, S, van Loveren, HR, Tew, JM Jr, Wiot, JG, Weil, SM, et al. Diagnosis and treatment of vascular brainstem malformations. J Neurosurgery 1990; 72: 27–34.CrossRefGoogle Scholar
33.Sadeh, M, Shacked, I, Rappaport, ZH, Radmor, R.Surgical extirpation of a venous angioma of the medulla oblongata simulating multiple sclerosis. Surg Neurol 1982; 17: 334–337.CrossRefGoogle ScholarPubMed
34.Steiger, HJ, Markwalder, TM, Reulen, HJ.Clinicopathological relations of cerebral cavernous angiomas: observations in eleven cases. Neurosurgery 1987; 21: 879–884.CrossRefGoogle ScholarPubMed
35.Weil, SM, Tew, JM Jr.Surgical management of brainstem vascular malformations. Acta Neurochir 1990; 105: 14–23.CrossRefGoogle ScholarPubMed
36.Yoshimoto, T, Suzuki, J.Radical surgery on cavernous angioma of the brainstem. Surg Neurol 1986; 26: 72–78.CrossRefGoogle ScholarPubMed
37.Simard, JM, Garcia-Benogochea, F, Ballinger, WE, Mickle, JP, Quisling, RG.Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery 1986; 18: 162–172.CrossRefGoogle ScholarPubMed
38.Sarkari, NBS, Bickerstaff, ER.Relapses and remissions in brainstem tumors. Br Med J 1969; 2: 21–23.CrossRefGoogle Scholar
39.Sze, G, Krol, G, Olsen, WL, Harper, PS, Galichich, JH, et al. Hemorrhagic neoplasms: MR mimics of occult vascular malformation. Am J Radiol 1987; 149: 1223–1230.Google Scholar
40.Yeates, A, Enzman, D.Cryptic vascular malformations involving the brainstem. Radiology 1983; 146: 71–75.CrossRefGoogle ScholarPubMed
41.Leeds, NE, Eklin, CM, Zimmerman, RD.Gliomas of the brain Semin Roentgenol 1984; 19: 27–43.Google Scholar
42.Atlas, SW, Grossman, RI, Gomorri, JM, Hackney, DB, Goldberg, HI, et al. Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging. Radiology 1987; 164: 71–77.CrossRefGoogle ScholarPubMed
43.Ebeling, JD, Tranmer, BI, Davis, KA, Kindt, GW, DeMasters, BK.Thrombosed arteriovenous malformations: a type of occult vascular malformation. Neurosurgery 1988; 23: 605–610.CrossRefGoogle ScholarPubMed
44.Gomorri, J, Grossman, R, Goldberg, H, Zimmerman, R, Bilaniuk, L.Intracranial hematomas: imaging by high-field MR. Radiology 1985; 157: 87–93.CrossRefGoogle Scholar
45.Rapacki, TFX, Brantley, MJ, Furlow, TW Jr, Geyer, CA, Toro, VE, et al. Heterogeneity of cerebral cavernous hemangiomas diagnosed by MR imaging. J Comp Assist Tomogr 1990; 14: 18–25.CrossRefGoogle ScholarPubMed