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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 58, Num. 5, 2010, pp. 813-814

Neurology India, Vol. 58, No. 5, September-October, 2010, pp. 813-814

Letter to Editor

Large cystic target lesion: An unusual presentation of cavernoma

Chhitij Srivastava1, Sunil K Singh1, Bal Krishna Ojha1, Anil Chandra1, Swati Srivastava2

1 Department of Neurosurgery, CSM Medical University, Formerly King George's Medical College, Lucknow - 226 003, U.P, India
2 Department of Pathology, Vivekanand Polyclinic Institute of Medical Science, Lucknow - 226 007, U.P, India

Correspondence Address:
Chhitij Srivastava
Department of Neurosurgery, CSM Medical University, Formerly King George's Medical College, Lucknow - 226 003, U.P
India
drchhitij@yahoo.co.in


Date of Acceptance: 06-Aug-2010

Code Number: ni10234

PMID: 21045532

DOI: 10.4103/0028-3886.72203

Sir,

Imaging characteristics of a large cavernoma are variable; they may be purely cystic or contrast-enhancing mass lesions. [1],[2],[3] This report presents a cavernoma with a large cystic target lesion with central core enhancement.

A 30-year-old lady presented with recurrent seizure, headache and left hemiparesis. Contrast computerized tomography (CCT) brain showed a well-defined lesion resembling the target of shooting rifle with central enhancing core and a well-demarcated surrounding hypodense halo along with perilesional edema [Figure - 1]. On magnetic resonance imaging (MRI), the central core demonstrated mixed intensity on both T1- and T2-weighted images; the surrounding halo was isointense on T1W and hyperintense on T2W images with blooming on Gradient Echo sequences. Contrast study showed irregular enhancement of central core, while the peripheral rim of halo was perfectly spherical and brilliantly enhancing [Figure - 2]. Cerebral angiogram revealed no abnormality.

At surgery, xanthochromic fluid was aspirated from the cystic lesion. Wall of the cyst was easily separable from the surrounding gliotic brain, and total excision of the lesion was done. Cut section of the specimen showed central area of soft, fragile reddish brown mass. Histopathology confirmed the diagnosis of cavernoma. At the 6-month postoperative follow-up, the patient is asymptomatic.

In brain lesions, central calcific nidus or central enhancement with surrounding enhancing ring has been considered as target sign. This sign was first described in intracerebral tuberculoma and was considered to be pathognomic of this lesion. [4] Target sign has also been reported in a case of metastatic adenocarcinoma. [5]

References

1.Curling OD, Kelly DL, Elster AD, Craven TE. An analysis of the natural history of cavernous angiomas. J Neurosurg 1991;75:702-8.  Back to cited text no. 1    
2.Chicani CF, Miller NR, Tamargo RJ. Giant cavernous malformation of the occipital lobe. J Neuroophthalmol 2003;23:151-3.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Thiex R, Kruger R, Friese S, Gronewaller E, Kuker W. Giant cavernoma of the brain stem: Value of delayed MR imaging after contrast injection. Eur Radiol 2003;13: L219-25.  Back to cited text no. 3    
4.Van Dyk A. CT of intracranial tuberculomas with specific reference to the "target sign". Neuroradiology 1988;30:329-36.  Back to cited text no. 4  [PUBMED]  
5.Kong A, Koukourou A, Boyd M, Crowe G. Metastatic adenocarcinoma mimicking 'target sign' of cerebral tuberculosis. J Clin Neurosci 2006;13:955-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

Copyright 2010 - Neurology India

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[ni10234f2.jpg] [ni10234f1.jpg]
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