Clinical Neurology and Neurosurgery 115 (2013) 1126–1127

Contents lists available at SciVerse ScienceDirect

Clinical Neurology and Neurosurgery

journal homepage: www.elsevier.com/locate/clineuro

Case report

A case of cavernous angioma in the septum pellucidum

Masahito Katoh a,∗ , Yutaka Sawamura b , Takuya Moriwaki a , Masami Yoshino a , Takeshi Aoki a ,
Takeo Abumiya a , Hiroyuki Imamura a , Toshimitsu Aida a
a
Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
b
Sawamura Neurology and Neurosurgery Clinic, Sapporo, Japan

a r t i c l e i n f o

Article history:
Received 25 June 2012
Accepted 3 September 2012
Available online 26 September 2012

Keywords:
Cavernous angioma
Septum pellucidum
Memory disturbance

1. Introduction Pathologically, there were a variety of vascular structures

Cavernous angioma can arise anywhere within the intracranial
cavity. However, it occurs very rarely in the ventricular system,
and its arising in the septum pellucidum without rupture into the
ventricle is extremely rare. This case is the first to be reported in
the available English literature.
without intervening neural tissue. There were sites of hemor-
rhage, macrophages engulfing hemosiderin, and inflammatory cell
infiltration. The diagnosis was cavernous angioma (Fig. 2). The
postoperative course was uneventful, but memory disturbance
remained unchanged (Table 1).

2. Case report 3. Discussion

A 44-year-old man was admitted to Hokkaido Neurosurgical
Memorial Hospital because of memory disturbance. Eleven months
before admission, a hematoma in the septum pellucidum was
incidentally found on MRI in another hospital, which performed
follow-up for another asymptomatic cavernous angioma in the
left putamen. Because the hematoma was asymptomatic, he was
followed up at an outpatient clinic. However, eight months after
hemorrhage, he noticed memory disturbance, and MRI revealed
angioma growth. He was referred to our hospital for surgery.
He could not recall events that had happened a few minutes
before. MRI revealed a hematoma localizing in the septum pellu-
cidum (Fig. 1) and a cavernous angioma with venous angioma in
the left putamen.
The lesion was completely removed through an anterior tran-
scallosal approach. The hematoma was confined to the septum
pellucidum, and there was no hematoma in the ventricle.
∗ Corresponding author at: Hokkaido Neurosurgical Memorial Hospital, Hachiken
9 Higashi 5, Nishi-ku, Sapporo 063-0869, Japan. Tel.: +81 11 717 2131;
fax: +81 11 717 2688.
E-mail address: masasama@ceres.ocn.ne.jp (M. Katoh).
Cavernous angiomas occur rarely in the ventricular system [1],
and their occurrence in the septum pellucidum is extremely rare.
This is the first report of cavernous angioma in the septum pellu-
cidum in the available English literature.
Narisawa et al. [2] reported a case of cavernous angioma involv-
ing the septum pellucidum with intraventricular hemorrhage. The
patient manifested headache and nausea, and the lesion was com-
pletely resected. She was discharged with no neurological deficit.
The present case involved severe memory disturbance, possibly
because such a confined hematoma in the septum pellucidum with-
out rupture to a ventricle may damage the bilateral fornices. The
fornix plays an important role in memory by connecting the hip-
pocampus with other structures involved with memory, including
the anterior thalami, septal nuclei, and mammillary bodies [3].
Korematsu et al. [4] reported a case of amnesia which resulted
from a single small unilateral infarction involving the left anterior
fornix. The amnesia persisted for more than 3 months. Whether
or not damage of the unilateral fornix will result in memory
disturbance is controversial, but damage to the bilateral fornices
will certainly cause memory disturbance [5].
The memory disturbance of the present case persisted for
more than 6 months, with only slight improvement (Table 1). A

0303-8467/$ – see front matter © 2012 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.clineuro.2012.09.010
 M. Katoh et al. / Clinical Neurology and Neurosurgery 115 (2013) 1126–1127 1127

Fig. 2. There were a variety of vascular structures without intervening neural tissue.

Table 1
Wechsler Memory Scale-Revised.

pre-OP post-OP 5 months after OP

Verbal memory 61 67 78
Visual memory 74 73 75
General memory 60 64 74
Attention/concentration 90 94 115
Delayed recall <50 <50 <50
OP: operation

hematoma within the septum pellucidum without ventricle rup-

ture may damage the fornix on both sides. Surgical removal should
be considered in the case of a bleeding cavernous angioma, which
may damage the fornix.

References

Fig. 1. MRI revealed a hematoma localizing in the septum pellucidum and a
cavernous angioma with venous angioma in the left putamen. (A) Axial image
(T2-weighted image) and (B) coronal image (T1-weighted image after gadolinium
administration).
[1] Reyns N, Assaker R, Louis E, Lejeune JP. Intraventricular cavernomas: three cases
and review of the literature. Neurosurgery 1999;44:648–54.
[2] Narisawa A, Kumabe T, Anzai T, Utsumi Y, Tominaga T. A case of cavernous
angioma at the septum pellucidum. No Shinkei Geka – Neurological Surgery
2007;35:53–8.
[3] Moudgil SS, Azzouz M, Al-Azzaz A, Haut M, Gutmann L. Amnesia due to fornix
infarction. Stroke 2000;31:1418–9.
[4] Korematsu K, Hori T, Morioka M, Kuratsu J. Memory impairment due to a
small unilateral infarction of the fornix. Clinical Neurology and Neurosurgery
2010;112:164–6.
[5] Hattingen E, Rathert J, Raabe A, Anjorin A, Lanfermann H, Weidauer S. Diffu-
sion tensor tracking of fornix infarction. Journal of Neurology, Neurosurgery and
Psychiatry 2007;78:655–6.