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Images in Neurology |

The Importance of Susceptibility-Weighted Imaging in Familial Cerebral Cavernous Malformation

Mesut Bulakci, MD; Tuba Kalelioglu, MD; Adem Kiris, MD
Arch Neurol. 2012;69(10):1376-1377. doi:10.1001/archneurol.2012.96.
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A 47-year-old male patient was admitted to our hospital with a headache. A family history of chronic headaches and seizures was noted. His initial neurologic examination and laboratory test results were normal. Nonenhanced cranial computed tomographic scans showed poorly defined areas of increased density in the left centrum semiovale (Figure 1A), in the areas adjacent to the anterior horn of the left lateral ventricle (Figure 1B), and in the cerebellum (Figure 1C). These lesions were also more conspicuous on conventional magnetic resonance imaging (MRI) sequences (T1- and T2-weighted spin echo sequences) and fluid-attenuated inversion recovery sequences (Figure 1D-F) than on computed tomographic scans. Magnetic resonance angiography of the brain showed no abnormal findings. The susceptibility-weighted imaging (SWI) sequences revealed numerous multifocal occult lesions elsewhere in the brain in apparent random volume distribution, establishing disease categorization as multifocal, as in familial cerebral cavernous malformation (CCM) disease (Figure 2).

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Figure 1. Computed tomographic scans and magnetic resonance imaging sequences in familial cerebral cavernous malformation. Nonenhanced cranial computed tomographic scans show several poorly defined areas of increased density (A-C). These lesions are more conspicuous on fluid-attenuated inversion recovery images (D-F).

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Figure 2. Axial susceptibility-weighted magnetic resonance images showing numerous hypointense nodules in the bilateral cerebral hemispheres (A and B) and the cerebellum (C).

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