J Korean Neurosurg Soc.  2014 Feb;55(2):89-91. 10.3340/jkns.2014.55.2.89.

Chronic Encapsulated Intracerebral Hematoma Associated with Cavernous Malformation

• Takeuchi S
• Wada K
• Sakakibara F
• Mori K

• KMID: 2191051
• DOI: http://doi.org/10.3340/jkns.2014.55.2.89

Abstract

Chronic encapsulated intracerebral hematoma (CEIH) is a rare cerebrovascular disease that behaves as a slowly expanding lesion with a gradual onset. It is well established that CEIH is associated with arteriovenous malformations; however, CEIH associated with cavernous malformation (CM) is extremely rare. We herein report a case of CEIH associated with CM, and discuss its pathogenesis. A 12-year-old female was admitted to our hospital because of a one week history of progressive headache and nausea. Brain computed tomography scan and magnetic resonance imaging showed an intracerebral hematoma surrounded by edema in the right frontal lobe. One week later, her headache and nausea worsened, and a brain computed tomography scan revealed the enlargement of hematoma. A right frontal craniotomy was performed. The capsule, mass, and hematoma were totally removed. Histological examination confirmed the diagnosis of CEIH associated with CM. Immunohistochemical analysis revealed increased expression of vascular endothelial growth factor (VEGF) and the VEGF receptor-1 in the endothelium and fibroblasts. Our findings suggest that the activated VEGF pathway might have positively contributed to development of CEIH in the present patient.

Keyword

Chronic encapsulated intracerebral hematoma; Cavernous malformation; Vascular endothelial growth factor

MeSH Terms

Arteriovenous Malformations
Brain
Child
Craniotomy
Diagnosis
Edema
Endothelium
Female
Fibroblasts
Frontal Lobe
Headache
Hematoma*
Humans
Magnetic Resonance Imaging
Nausea
Vascular Endothelial Growth Factor A
Vascular Endothelial Growth Factor A

Figure

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  Fig. 1 Imaging findings at 21 months of age. Axial T1-weighted (A), T2-weighted (B), and proton density (C) magnetic resonance images show no evidence of any lesions.

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  Fig. 2 Imaging findings during admission. A : Computed tomography (CT) scan on admission shows an intracerebral hematoma surrounded by edema in the right frontal lobe. B, C, and D : Axial T1-weighted (B), T2-weighted (C), and T2*-weighted (D) MRI reveal a mass lesion as mixed intensities. E : CT scan obtained one week after admission shows progression of hematoma. F : Postoperative CT scan shows total removal of the lesion.

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  Fig. 3 Histopathological findings. A : Specimen (H&E) taken from the lobulated mass shows thin-walled dilated vascular channels with no intervening brain parenchyma, thus suggesting the presence of cavernous malformation. B : Specimen (H&E) of the capsule shows its structure consisting of an outer collagenous layer and an inner granulated layer with deposits of hemosiderin, which is compatible with chronic encapsulated intracerebral hematoma. C : Immunohistochemistry for vascular endothelial growth factor (VEGF) reveals positive immunostaining in the endothelium and fibroblasts. Original magnification : 400×. D : Immunohistochemistry for VEGF receptor-1 reveals positive immunostaining in the endothelium and fibroblasts. Original magnification : 400×.

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