Cerebellar Hemangioblastoma

• Benign neoplasm
• 80% found in cerebellum
• Remainder in spinal cord > medulla > cerebrum
• Account for 10% of posterior fossa masses (vestibular schwannomas and metastases rule here.)
• Occur in ages 30 to 40
• M > F
• Relationship to von Hippel-Lindau disease
• 20% occur in patients with von Hippel-Lindau disease (multiple lesions).
• 35-60% of von Hippel-Lindau disease patients have hemangioblastomas
• von Hippel-Lindau disease
• Hemangioblastomas
• Clinical findings
• Headache
• Ataxia
• Nausea
• Vomiting
• Vertigo
• Polycythemia caused by increased erythropoietin found in 40%.
• Spinal lesions may present with subarachnoid hemorrhage
• Findings on CT and MRI:
• Cystic lesion in the cerebellum with an avidly enhancing mural nodule (75%)
• Purely solid enhancing lesion (10%)
• Enhancing lesion with multiple cystic areas (15%)
• Findings on angiography:
• Vascular nodule within an avascular mass
• Serpentine vessels
• Treated with surgical removal of solid nodule
• Cystic component is not neoplastic
• DDx:
• Similar appearance to Juvenile pilocytic astrocytoma
• But that is typically found in patients 5 to 15 years of age   

 
Cerebellar Hemangioblastoma. MRI of brain shows a cystic lesion in the cerebellum with an enhancing nodule (post-Gadolinium)