A “pseudo-cavernoma” – An encapsulated hematoma of the choroid plexus

Abstract

We present the first report of an intraventricular encapsulated hematoma, mimicking cavernous malformation on imaging and gross lesion appearance. A 47-year-old female on anticoagulation therapy for atrial fibrillation presented with left upper extremity apraxia, neglect, and mild gait imbalance. Her brain CT scan and MRI revealed multilobulated lesions involving the choroid plexus in the atria of both lateral ventricles. The intraoperative appearance was that of encapsulated mass, with blood clots at different stages of liquefaction and organization, all consistent with the gross appearance of a cavernous malformation. However, histopathologic examination demonstrated hematoma with components at different ages, and normal vessel infiltration without any hint of cavernous malformation histology, or underlying neoplasia. Encapsulated hematoma should be considered in the differential diagnosis of hemorrhagic intraventricular masses.

Chronic Encapsulated Intracerebral Hematoma as an Occasional Finding in Sudden Cardiac Death

“…Thrombosis or vascular damage followed by a small intracranial hemorrhage could lead to the formation of a chronic organized hematoma [ 17 ] but the mechanism of the capsule formation, the progressive expansions and eventually its resolution is still unclear [ 6 ]. CEIH can mimic cerebral tumors, or vascular abnormalities [ 18 ]. It can be found in the subcortical region in approximately 80% of cases.…”

“…The ventricular localization is rare due to the rapidly absorption through the ventricular system and for this reason infrequently undergoes encapsulation. Details of age, sex, presentation, imaging findings, pathology, and outcome of seven cases of CEIH reported in the literature [ 18 , 20 , 21 , 22 , 23 , 24 ] are summarized in Table S1 in Supplementary Materials . In our case, the hematoma was in the right lateral ventricle with no documented symptomatic mass effect.…”

Chronic encapsulated intraventricular hematoma in a pediatric patient: case report

“…18,30 The use of antiplatelets and anticoagulation may have a role in the progression of CEIH and CEIVH. 6 Hypertension may be associated with the formation of CEIH. 5,16 No etiology is found for many cases of CEIH.…”

“…Patients present with seizures, hemiparesis, ataxia, and other focal neurological deficits. 6,8,16,24 Moreover, common presentations include signs of increased intracranial pressure, such as headaches, papilledema, nausea, and vomiting. 5,13 Our patient presented with headaches related to early entrapment of the temporal horn of the lateral ventricle, which resolved after complete resection.…”

“…22 To our knowledge, only 5 cases of chronic encapsulated intraventricular hematoma (CEIVH) have been reported in 4 papers. 2,6,13,23 Of these, only 1 case has occurred in a child; however, its report dates back to 1955. 2 The etiology of these lesions is not well defined.…”