Cerebral Cavernous - Dr. Vikas Gupta

Cerebral cavernous malformations (CCMs) are also known as cavernomas, cavernous angiomas, cavernous hemangiomas, or capillary hemangiomas found in approximately 0.5% of the population. They are abnormal clusters of capillaries and venules that repeatedly bleed over time and give rise to a “popcorn-like” lesion or raspberry-like lesion in the brain or spinal cord. The blood present in these lesions is due to bleeding which happened at different times.

They can be hereditary and hence run in families or can develop on their own. The exact cause of why a cavernous malformation occurs is unclear. They can also occur after focal brain radiation.

A cavernoma can remain silent, without any symptoms till it bleeds or grows in size, enough to cause pressure symptoms on the surrounding brain tissue. Repeated bleeding in the surrounding tissue irritates the brain due to the presence of blood or blood clots. Depending upon the site of cavernoma, it can produce symptoms such as:

• Seizures
• Visual disturbances
• Imbalance
• Memory deficits
• Incoordination
• Motor deficits
• Headache
• Weakness or numbness of one or more limbs
• Improper speech
• Poor comprehension

Repeated bleeding and clotting causes these symptoms to progressively worsen over time. However, if a large amount of bleed has occurred, causing a brain hemorrhage, it is an emergency and rapid treatment is required as it can endanger life. Symptoms of brain hemorrhage are:

• Nausea and vomiting
• Seizures
• Sudden, severe headache
• Imbalance
• Speech abnormalities
• Incoordination
• Double vision or other speech abnormalities

Since they can remain symptomless for a long period or present with few symptoms, they are predominantly diagnosed in patients undergoing a cerebral workup for some other disease, therefore, primarily an incidental finding.

Due to bleeding into the brain tissue, they are better diagnosed on various specialized MRI sequences. They cannot be diagnosed in angiography.

Medications are not curative for CCM but they can be used to give relief from symptoms like seizures or headache caused by it. Therefore, surgery is the only available treatment option.

Being angiographically occult lesions, they cannot be treated by endovascular surgery, and precise image-guided microsurgery is done via minimal access route. Radiosurgery is usually effective and is considered only in deep-seated locations like the brain stem