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| T1 sagittal pre gad | T1 axial post gad | T1 coronal post gad |
Diagnosis: Hemangioblastoma
Hemangioblastomas usually occur sporadically. Only 20% of hemangioblastomas are associated with von Hippel-Lindau disease. Hemangioblastomas usually present in adults with progressive gait disturbance, nausea, vomiting or vertigo. They are most commonly in the posterior fossa, however approximately 10% may be in the spinal cord. They are exceedingly rare above the tentorium. Multiple lesions are seen in only in VHL. They classically present as a cystic posterior fossa mass with a intensely enhancing mural nodule without calcification however, 1/3 of hemangioblastomas are solid. The cyst wall may show some enhancement. Hemangioblastomas may produce erythrocytosis secondary to secretion of the hormone erythropoietin. Flow voids may be seen and suggest a vascular tumor such as hemangioblastoma. Tumors which may mimic a hemangioblastoma are cystic metastasis and astrocytoma. Juvenile pilocytic astrocytoma may resemble this; however, the patient's age goes against this diagnosis. The combination of a cystic posterior fossa mass without appreciable cyst wall enhancement and a focal, intensely enhancing mural nodule supports the diagnosis of hemangioblastoma. Related Cases
