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Case Report: A cerebellar abnormality
EP34298
Poster Title: Case Report: A cerebellar abnormality
Submitted on 29 Oct 2020
Author(s): Jennifer Wetherall
Affiliations: Salford Royal Foundation Trust
Poster Views: 40
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Poster Information
Abstract: Cavernous angiomas are a developmental type of intracranial vascular malformation which can be inherited or idiopathic. They are formed of a cluster of dilated weak-walled capillaries. They often present following a haemorrhage event in young adults as a range of neurological signs and symptoms, depending on the location of the lesion. They are best evaluated on MRI, which can also reveal associated developmental venous abnormalities.

This case presents a 41-year-old female who attended A&E with a four-day history of progressive dyscoordination of her left arm, unsteadiness with falls to her left side, frontal headache and nausea and vomiting. Examination revealed marked instability on standing causing her to fall to the left, and frank dysmetria, tremor and dysdiadochokinesis on the left.

A CT angiogram showed a hyperdense mass located on the superior cerebellar vermis with an area of calcification. No cerebral aneurysm or other vascular abnormality was demonstrated. An MRI the following day showed findings suggestive of a cavernous malformation. This mass appeared to be low signal on T2 imaging with minor high signal change on T1 scans, suggestive of an encapsulated haematoma. There was evidence of recent haemorrhage inferiorly which extended into the left cerebellum and subarachnoid space. Inferiorly there was an area of calcification associated with a developmental venous abnormality.

She was admitted under the neurovascular surgical team for 2 weeks and treated symptomatically and conservatively with antiemetics and received physiotherapy. Following improvement in her mobility she was discharged to await a repeat MRI scan as an outpatient.

Although rare, cavernous malformations are an important cause to consider in young people presenting with stroke symptoms. Due to the familial association it is important to screen other family members. They are normally managed conservatively but complications include persisting neurological symptoms, epilepsy, mass effect or hydrocephalus, in which cases surgery may be required.
Summary: This case reports describes a fourty-one year old female who had progressive left sided cerebellar symptoms and signs. An MRI revealed the diagnosis of a cavernous malformation with associated encapsulated haematoma. References: [1] https://www.ncbi.nlm.nih.gov/books/NBK430871/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543067/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553676/
[4] https://www.ahajournals.org/doi/full/10.1161/strokeaha.117.017074
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