We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Intraventricular Cavernous Malformation With Superficial Siderosis

Shyamsunder B. Sabat, MD
Arch Neurol. 2010;67(5):638-639. doi:10.1001/archneurol.2010.53.
Text Size: A A A
Published online


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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

Magnetic resonance imaging of the brain. A, A T2-weighted scan shows a small amount of settled blood in both occipital horns (arrows). B, A T1-weighted image shows a lobulated heterogeneous mass attached to the left lateral ventricular wall with hyperintensities. There is also mild hydrocephalus. C, A T2-weighted image shows a rim of marked hypointensity with hyperintense foci highly suggestive of cavernous malformation. D, A T2-weighted image shows the pial lining of the brain to be very dark, consistent with hemosiderin deposits (arrows). E, A T2*-weighted angiographic image, a susceptibility-weighted imaging sequence, shows the dark hemosiderin lining very prominently (arrows). F, A normal T2-weighted magnetic resonance image of a different patient serves as a control for comparison with part D.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles