Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 2, 2010, pp. 332-333

Neurology India, Vol. 58, No. 2, March-April, 2010, pp. 332-333

Neuroimage

Coexistence multiple intracerebral, spinal cavernous angiomas and multiple intracerebral meningiomas

Gong Chen, Bing Leng, Donglei Song, Qihong Wang

Department of Neurosurgery, Huashan Hospital; Neurosurgical Department, Shanghai Medical College; Fudan University, Shanghai, China

Correspondence Address: Qihong Wang, Department of Neurosurgery, Huashan Hospital, Neurosurgical Department, Shanghai Medical College, Fudan University, No.12, Wulumuqi Mid Road-200 040, Shanghai, China, onlycgcqy@yahoo.com.cn

Date of Acceptance: 29-Oct-2009

Code Number: ni10090

PMID: 20508370

DOI: 10.4103/0028-3886.63771

A 34 year old female presented with motor and sensory deficits of both the lower extremity. Computed tomography (CT) scan showed multiple hyperdense lesions in both the hemispheres. Non-contrast magnetic resonance imaging (MRI) of the brain revealed multiple intracerebral mixed intensity lesions with peripheral hemosiderin ring on T2-wighted sequence. MRI of the spine showed an intramedullary mixed intensity lesion at the T12-L1 level [Figure - 1]. Most of the lesions showed central hyperintensity and peripheral hypointensity on the T2-weighted sequence [Figure - 1]. Contrast MRI brain showed two homogeneously enhanced lesions in the convexity of bilateral temporal lobes [Figure - 2]. These lesions were not apparent on both CT scan and T1 or T2 weighted MRI. Cerebral and spinal angiograms were normal. Systemic screening for other organ involvement was negative. There was no family history of similar illness in any of the near family members.

The diagnostic consideration was multiple intracerebral cavernous angiomas (CA) with bitemporal convexity menigiomas and intramedullary spinal CA. Most meningiomas are isointense on T1 and T2 weight sequences and a small meningioma may be missed on unenhanced MRI because of the intensity similar to that of cerebral cortex. The occurrence of multiple intracerebral CAs and/or spinal CAs with intracranial meningioma is rather rare more so with no family history, radiotherapy or operation. Literature review reveals six cases of solitary intracerebral CA with spinal CA, ^[1] two cases with multiple intracerebral CAs and single spinal CA, ^[2] one case with intracerebral single CA and single meningioma, and two cases with intracerebral multiple CAs associated with single meningioma. ^[3],[4] To the best of our knowledge, probably this is the first case of such combination.

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