A 50-year-old man was referred for subacute intracranial hypertension. MRI revealed a well-circumscribed lesion in the posterior fossa that was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging (figure 1, A and E). Cerebral blood volume map and sequential postcontrast T1-weighted images showed progressive increase in the homogeneity of the contrast enhancement, indicating that the lesion had low but substantial flow (figure 1, B–D). Digital subtraction angiography showed a vascular lesion with a central to peripheral pattern of vascularity and absence of early venous return (figure 1, F–H). The lesion was resected. Pathologic examination revealed a capillary-venous malformation (figure 2).1,2 This case highlights that MRI can identify low flow in vascular malformations.
T1-weighted imaging (A) and T2-weighted imaging (E). Central high perfusion on the cerebral blood volume map (dynamic susceptibility contrast perfusion) (B), progressive enhancement on T1-weighted imaging immediately after injection (C), and 5 minutes later (D). Progressive vascular filling on digital subtraction angiography: arterial phase (F), intermediate phase (G), and late phase (H).
Paraffin-embedded section stained with hematoxylin & eosin–Safran shows large blood vessels with thin walls. Absence of proliferating cells; no expression of GLUT1. This can be defined as capillary-venous malformation according to the International Society for the Study of Vascular Anomalies classification system.
Footnotes
Author contributions: Dr. Heck: design and conceptualization of the study, analysis and interpretation of the data, drafting and revising the manuscript for intellectual content. Dr. Krainik: revising the manuscript for intellectual content. Dr. Boubagra: analysis and interpretation of the data. Dr. Tahon: analysis and interpretation of the data. Dr. Attye: revising the manuscript for intellectual content. Dr. Le Bas: revising the manuscript for intellectual content. Dr. Boutonnat: analysis and interpretation of the data. Sylvie Grand: design and conceptualization of the study, analysis and interpretation of the data, drafting and revising the manuscript for intellectual content.
Study funding: No targeted funding reported.
Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- © 2014 American Academy of Neurology
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