gms | German Medical Science

The authors report on a patient who presented with an intracerebral hemorrhage in the left temporal lobe and an intraventricular mass located at the level of the left foramen of Monroi.

This 57-year-old man was initially admitted to stroke unit with acute exacerbation of the pre-existent dysarthria und hemiparesis of the right side after a stroke in 2008.

Initial CT scans demonstrated a 15-mm hyperdense lesion within the left lateral ventricle that was mostly occupying the left foramen of Monroi and the intracerebral hematoma (ICH) in the left temporal lobe without manifest compression of the brainstem and without midline shift. A cerebral CT-angiographie revealed no pathological vascularisation.

On day 7 after admission the patient deteriorated to somnolent state und became hemiplegic. Emergency CT demonstrated an increase of the ICH size in the left temporal lobe with midline shift and uncal herniation. No changes in the intraventricular mass occurred. The ICH was then removed via osteoplastic kraniotomie using microsurgery. Histopathological findings identified no vascular malformations.

After the rehabilitation und re-admission 5 month later a definitive MR-navigated microsurgical removal of the ventricular mass via transventricular approach was ultimately performed.

Histopathological findings confirmed the diagnosis of cavernous angioma.

The postoperative course was uneventful. The patient was discharged on the 6th day after surgery with no further neurological impairment.

This is a case of a save treatment of a rare intraventricular pathological entity. Surgery is advocated in cases of repeated bleeding and to eliminate the mass effect of the cavernoma.