Angiomatous Malformation as a Cause of Cerebral Calculus

The term cerebral calculus has been used to describe the radiological appearance of certain abnormal inttacranial calcifications, solitary or multiple) ,4 The etiology of these ealcifications is varied.6.7,~3,2t In most of the reported cases, calcification of an intraeerebral hematoma,~0 tuberculomaS,~0 or brain abscess was considered to be the underlying cause. Massive intracranial ealcification and ossification caused by angiomatous malformation has not been repolted previously. Case Report S.G., a 16-year-old Negro girl, came to the Epilepsy Clinic on January 6, 1965, with a 7-year history of grand real She began to have seizures when 10 years old. The seizures usually began with flashes of light and spots in the right visual field. These unformed visual hallucinations persisted for about 10 minutes, with nausea and occasional vomiting, followed by a generalized seizure with tonic-clonic phases. The patient had been placed on Dilantin and Phenobarbital by her local physician, with poor results. At the age of 9 years, she had sustained a minor head injury in an automobile accident, but did not lose consciousness. Skull x-rays were not made at that time. The past history was otherwise not remarkable. There was no family history of seizures. Examination. The general physical findings were normal. There were no bruits over the head or neck. The neurological examination showed a normal mental status. The visual acuity was ~0/~0 without correction. Visual fields, by tangent screen and perimeter, were normal. Ocular fundi were normal with no evidence of angiomatous lesions in the retina. The rest of the cranial nerve examination and detailed motor, sensory and coordination tests were all normal. The spinal fluid was clear and colorless, the pressure was 180 mm. of water. Spinal fluid protein was 80 rag. /100 ml. There were no cells in the spinal fluid. The white blood cell count was 6,500, the hematocrit 40 per cent, the urine analysis normal, and a fasting blood sugar 88 mg./100 ml. An x-ray of the chest was normal. A brain scan, using radioactive Hg ~08 was normal at ~0 minutes and at 1~0 minutes following injection of the isotope. The electroencephalogram was normal; photic driving showed well-developed alpha rhythms. Skull x-rays revealed a calcified mass, 4 era. in diameter, in the left occipital region. The mass appeared above the level of the tentorium and did not seem to be attached to the inner wall of the skull (Fig. 1). The calcification appeared diffuse and slightly lobulated, with some mottling.