suprasellar cavernous malformation presenting with extensive subarachnoid hemorrhage

Introduction Cavernous malformations are usually intraparenchymal, extra-axial lesions being uncommon. They have very rarely been reported as the cause of subarachnoid hemorrhage. We present a woman who developed a massive subarachnoid hemorrhage from a suprasellar cavernous malformation, which was largely, if not en- tirely, extra-axial. Case report A 40-year-old Hispanic woman who had no significant prior medical history came to the Emergency Department after she fell twice and was developing increasing confusion. Her mental status had report- edly been declining for 3 weeks. She was oriented to time and per- son, but not to place, and had mildly slurred speech. She did not complain of headache or other symptoms, and was marginally coop- erative in answering questions and with her examination. In the Emergency Department, she had a respiratory arrest, and was ur- gently intubated. She then underwent a non-contrast head CT scan, immediately following which she had a cardiac arrest, from which she was resuscitated. She was then taken to the Intensive Care Unit. A ventriculostomy was placed to treat the hydrocephalus shown on CT, and an attempt was made to control her elevated intracranial pressure. Additional abnormal findings included a urinalysis with 10±30 white blood cells WBC) per high power field, moderate WBC clumps, red cells, and many bacteria later identified as E. coli) and a lumbar puncture which showed bloody cerebrospinal flu- id CSF) which contained WBC, and E. coli. The patient remained unresponsive, and had a repeat CT study. After discussion with the family, medical support was removed and the patient died shortly thereafter. A postmortem examination was then performed. The initial CT showed dense subarachnoid hemorrhage filling the chiasmatic cistern, extending along the course of the middle ce- rebral arteries bilaterally and into the pontine and perimesence- phalic cisterns. A mass with chunky calcification and a density similar to the subarachnoid blood extended from the suprasellar region superiorly toward the foramen of Monro. The lateral ventri- cles were mildly enlarged Fig. 1a±c). Further smaller dense lesions were present in the peripheral frontal white matter on each side. DIAGNOSTIC NEURORADIOLOGY E. J. Escott D. Rubinstein A. G. Cajade-Law C. I. Sze Suprasellar cavernous malformation presenting with extensive subarachnoid hemorrhage Received: 21 March 2000 Accepted: 3 October 2000 E. J. Escott ) ) ´ D. Rubinstein ´ A. G. Cajade-Law Section of Neuroradiology, Department of Radiology, University of Colorado Health Sciences Center, 4200 East Ninth Ave, Campus Box A034, Denver, CO 80262, USA e-mail: [email protected] Tel.: + 1-3 03-3 72 62 22 Fax: + 1-6 03-8 53 62 19 C.I. Sze Department of Pathology, University of Colorado Health Sciences Center, 4200 East Ninth Ave, Denver, CO 80262, USA Abstract Cavernous malformations are usually intraparenchymal, extra- axial lesions being uncommon. They have very rarely been reported as the cause of subarachnoid hemorrhage. We present a case of hemorrhage related to a cavernous malformation, unusual in two ways. First, it is rare for an intracranial cavernous malformation to present with massive subarachnoid hemorrhage. Secondly, this cavernous malformation lay in the chiasmatic cistern. Key words Cavernous angioma ´ Hemorrhage, subarachnoid hemorrhage Neuroradiology 2001) 43: 313±316 Ó Springer-Verlag 2001

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