CEREBRAL ANGIOMA

Overview
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Seizure Classification
Generalized onset seizure
- Motor Onset
- Non-Motor Onset
Focal Onset Seizure
- By Onset Feature
- Focal to Bilateral Tonic-Clonic
- Hemispheric lateralization
- Lobar localization
  - Frontal
  - Temporal
  - Parietal
  - Occipital
Unknown Onset Seizure
Epilepsy Classification
Generalized Epilepsy
Focal Epilepsy
Generalized and Focal Epilepsy
Unknown Epilepsy
Epilepsy Syndromes
Neonatal/Infantile
- Self-limited neonatal seizures and Self-limited familial neonatal epilepsy
- Self limited familial and non-familial infantile epilepsy
- Early myoclonic encephalopathy
- Ohtahara syndrome
- West syndrome
- Dravet syndrome
- Myoclonic epilepsy in infancy
- Epilepsy of infancy with migrating focal seizures
- Myoclonic encephalopathy in non-progressive disorders
- Febrile seizures plus, genetic epilepsy with febrile seizures plus
Childhood
- Epilepsy with myoclonic-atonic seizures
- Epilepsy with eyelid myoclonias
- Lennox-Gastaut syndrome
- Childhood absence epilepsy
- Epilepsy with myoclonic absences
- Panayiotopoulos syndrome
- Childhood occipital epilepsy (Gastaut type)
- Photosensitive occipital lobe epilepsy
- Childhood epilepsy with centrotemporal spikes
- Atypical childhood epilepsy with centrotemporal spikes
- Epileptic encephalopathy with continuous spike-and-wave during sleep
- Landau-Kleffner syndrome
- Autosomal dominant nocturnal frontal lobe epilepsy
Adolescent/Adult
- Juvenile absence epilepsy
- Juvenile myoclonic epilepsy
- Epilepsy with generalized tonic-clonic seizures alone
- Autosomal dominant epilepsy with auditory features
- Other familial temporal lobe epilepsies
Any Age
- Familial focal epilepsy with variable foci
- Reflex epilepsies
- Progressive myoclonus epilepsies
Epilepsy Etiologies
Genetic Etiology
- Chromosomal abnormalities
- Gene abnormalities
Structural Etiology
- Malformations of cortical development
- Vascular malformations
- Hippocampal sclerosis
- Hypoxic-Ischemic
- Traumatic brain injury
- Tumors
- Porencephalic Cyst
Metabolic Etiology
Immune Etiology
- Rasmussen syndrome
- Antibody mediated
Infectious Etiology
Unknown Etiology
- Febrile infection related epilepsy syndrome
Epilepsy imitators

CEREBRAL ANGIOMA

Imaging

Imaging for optimized detection of cerebral angioma:

Gradient echo (GRE) or T2* sequences are able to delineate these lesions better than T1 or T2 weighted images, and GRE/T2* images are very important in detecting angiomas, that may be missed by conventional spin echo sequences. Susceptibility weighted imaging (SWI) may have sensitivity equal to that of GRE in detecting angiomas. SWI is also highly sensitive in detecting calcification as compared to T1 and T2 images. Unless large, or associated with hemorrhage, these abnormalities are not seen on CT. Cerebral angiomas are not seen on angiography, as they are 'slow flow' abnormalities.

Imaging characteristics of cerebral angioma:

a mass with a characteristic "popcorn"" or "berry" appearance, with a rim of hemosiderin, which demonstrates prominent blooming on susceptibility weighted sequences
T1 and T2 signal is varied internally due to degrading hemorrhage of varying age

Imaging of cerebral angiomas

The image below, a T2* image, shows two punctate hypointense foci ('black dots') in the left occipital region (arrows), with others in the frontal lobes.

cerebral angioma 1