A 32-year-old woman presents with progressive headache and ataxia. MRI shows a multicystic lesion with a fluid-fluid level in the left cerebellar hemisphere, containing blood products of differing ages, with a complete rim of hypointensity on gradient echo sequences. Digital subtraction angiography is normal. The most likely diagnosis is:
- A Arteriovenous malformation
- B Cavernous malformation ✓
- C Developmental venous anomaly
- D Capillary telangiectasia
Correct answer: B. Cavernous malformation
Explanation
Cavernous malformations have the classic 'popcorn' appearance: a lobulated mass of haemorrhages in various stages with a surrounding haemosiderin rim that blooms on gradient echo or susceptibility weighted sequences. They are angiographically occult, so a normal DSA is expected and actually supports the diagnosis. An arteriovenous malformation would show enlarged feeding arteries and early draining veins on angiography, which kills that distractor.
Reference: Osborn's Brain: Imaging, Pathology, and Anatomy, 2nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.