A cavernoma (cavernous malformation) is a mulberry-like cluster of thin-walled blood vessels. Most cause no symptoms; some present with small bleeds or seizures.
What is a cavernoma?
A cavernoma is a benign cluster of thin-walled, dilated vascular spaces in the brain or spinal cord. It contains slow-flowing blood and has a typical "popcorn" or mulberry appearance on MRI. Unlike arterial lesions it is a low-pressure lesion, so bleeds are usually small and contained.
Cavernomas may be single or multiple. In people with multiple cavernomas and a similar family history, a hereditary (familial) form may be present.
Symptoms
- Seizures (the most common symptom)
- Headache
- Sudden weakness, numbness, double vision, imbalance or speech disturbance due to bleeding
- Cranial nerve symptoms such as difficulty swallowing or facial weakness with brainstem cavernomas
Diagnosis
Cavernomas are usually not visible on angiography; MRI, particularly sequences sensitive to blood products (SWI, gradient echo), is essential for diagnosis. Genetic counselling may be recommended for patients with multiple lesions.
Treatment Approach
- Observation: Most cavernomas that cause no symptoms are monitored with regular MRI.
- Medication: Anti-seizure medication is used for patients presenting with seizures.
- Surgery: Surgical removal is considered for symptomatic cavernomas that bleed repeatedly, cause seizures not controlled by medication, or lie in accessible areas.
- Radiosurgery: May be considered as an option for selected deep-seated cavernomas with repeated bleeding where surgical risk is high.