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Clinical Review Lesson of the week

Cavernous haemangioma mimicking multiple sclerosis

BMJ 1999; 318 doi: (Published 12 June 1999) Cite this as: BMJ 1999;318:1604
  1. M Zameel Cader, house officer,
  2. J B Winer (, consultant neurologist
  1. Department of Neurology, Queen Elizabeth Hospital, Birmingham B15 2TT
  1. Correspondence to: Dr Winer
  • Accepted 9 November 1998

Patients diagnosed with multiple sclerosis before the advent of magnetic resonance imaging and whose symptoms could be attributable cavernous haemangioma should be reviewed with magnetic resonance imaging

Cavernous haemangiomas are vascular malformations that rarely affect the brain, but their clinical presentation can simulate multiple sclerosis. The likelihood of mistaking cavernous haemangioma for multiple sclerosis is increased further by the fact that cavernous haemangiomas are poorly identified by angiography, and even computed tomography has a relatively low sensitivity and specificity for these lesions.1 However, high field magnetic resonance imaging is able to distinguish cavernous haemangiomas, and since its introduction increasing numbers have been reported.1

We describe two patients who had been diagnosed as having multiple sclerosis many years before the widespread use of computed tomography or the advent of magnetic resonance imaging. Magnetic resonance imaging subsequently showed that they had cavernous haemangioma.

Case reports

Case 1

A 17 year old boy presented in 1975 with diplopia, left sided facial weakness, and dizziness. He was right handed. Physical examination showed that he had left VI nerve palsy and mild weakness of the lower left side of his face. The patient was admitted to hospital for further investigation. A lumbar puncture showed clear cerebrospinal fluid under normal pressure but a slightly high γ globulin fraction (0.04 g/l; 12.1% of total protein), a red cell count of 4×109/l, and a white cell count of 1×109/l.

The patient's facial …

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