A patient comes with proptosis and Abducent N palsy. A dark homogenous mass on T2W MRI is seen which shows intense enhancement with contrast. Diagnosis is?

Ans. A. Cavernous hemangiomaExtraaxial cavernous hemangiomas: Rare and very rarely arise in the cavernous sinus. Although this malformation is categorized as a vascular malformation and has well-defined histologic characteristics, it sometimes presents tumor like behavior, including mass effects, enclosure of neurovascular structures, and proliferation during pregnancy.The lesions are found predominately among women.The onset of symptoms is usually insidious, and symptoms are caused by the large size of the lesions.Patients usually present with headaches and dysfunction of the cranial nerves passing through the cavernous sinus, manifesting particularly as ptosis and diplopia. MRI reveals well-defined masses that are Hypointense or isointense on t1-weighted images and markedly hyper intense on t2-weighted images, which indicates the relationship between the lesion and the intracavernous ICA.The marked hyper-intensity on t2-weighted images and homogenous enhancement seem to distinguish these lesions from other types. Meningiomas often similar signal intensity to gray matter on both t1- and t2-weighted images.Schwannomas tend to give lower signal intensity than gray matter on t1-weighted images and almost uniformly give higher signal intensity on t2-weighted images.Both Schwannomas and meningiomas show prominent contrast enhancement, which tends to be a slightly heterogeneous pattern.