A 60-year-old woman presented with imbalance, gait disturbances, and headaches of about 4 months' duration. Motor examination revealed some right-sided drift with mild tremor. Her gait was slow and broad-based. Cerebellar examination revealed minimal dysmetria on the right. Speech was slow with difficulty in word finding. Computed tomography revealed intraventricular hemorrhage, mild hydrocephalus, and a left ventricular mass. Magnetic resonance imaging was performed (Figure). The T1- and T2-weighted images showed a lobulated, heterogeneous mass of mixed signal intensity (like popcorn) with hyperintense as well as markedly hypointense areas. The brain pial surfaces were markedly hypointense, seen better in the brainstem region. To better depict these changes, susceptibility-weighted imaging—a new, promising magnetic resonance imaging technique—was used. Using the T2*-weighted angiography sequence (GE Healthcare, Chalfont St Giles, England), susceptibility-weighted images demonstrated marked blooming of the diffuse pial hypointensity. A provisional diagnosis of intraventricular cavernous malformation with superficial siderosis was made; this diagnosis was confirmed later at biopsy. The patient had presumably developed the condition from recurrent subclinical hemorrhagic episodes, a known phenomenon.
Sabat SB. Intraventricular Cavernous Malformation With Superficial Siderosis. Arch Neurol. 2010;67(5):638-639. doi:10.1001/archneurol.2010.53