Abstract Details

Title Cavernous Malformations: A Mini-Case-Series on Diagnosis and Management

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-007

Objective Mini-case series highlighting diagnosis and management of patients at our facility presenting with cavernous malformations (CMs).

Background CMs affect roughly 0.2-0.4% of the population. Majority of the cases are sporadic, however, autosomal dominant familial presentation can occur manifesting as multiple CMs. Presentation varies from asymptomatic to symptomatic with seizures, focal neurologic deficits, headaches, and cerebral/extra-cerebral bleeds. Within the CNS, CMs can occur throughout the CNS, with the incidence of 80% being supratentorial, 15% present infratentorial, and 5% in the spinal cord. Treatment options for include observation, microsurgical resection, or stereotactic radio-surgery. We present a mini-case series of diagnosis and management of 4 patients with cavernous malformations.

Design/Methods Case Series

Results This series highlights four patients who presented to our facility within twelve months with diagnosis of CM. The average age of cases was 51, with the male to female ratio of 2:2. Three patients presented with headache and visual complaints, one presented with neck and multiple joint pain secondary to other etiologies. MRI showed the characteristic diagnostic “pop-corn” appearance in 3 cases (2 intracranial, one spinal). These patients were asymptomatic and conservatively managed. One patient demonstrated coexistence of two distinct cavernous malformations with multifocal micro-hemorrhages, potentially representing occult CMs. One patient had recurrent symptomatic intracerebral hemorrhage of unclear etiology with no radiographic or angiographic evidence. The cases with radiographically relevant CMs underwent conservative management, and the case with angiographically occult lesion required craniotomy for microsurgical resection of suspected cavernous malformation, which was later confirmed on biopsy.

Conclusions The series above highlights the common manifestations of intracranial or spinal cavernous malformation as variable presentations, manifesting frequently with headache and focal neurological deficits. Cavernous malformations have a wide range and can pose a diagnostic challenge as they can be angiographically silent and may warrant neurosurgical intervention.

Authors/Disclosures
Khadija Awais, MBBS (University of Tennessee GME) PRESENTER	Dr. Awais has nothing to disclose.
Chetan Saini, MD (The University of Tennessee Health Science Center)	Dr. Saini has nothing to disclose.
Balaji Krishnaiah, MD, FAAN (University of Tennessee Health Sciences Center)	Dr. Krishnaiah has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for ACP. Dr. Krishnaiah has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Merck Manual. Dr. Krishnaiah has received publishing royalties from a publication relating to health care.
Nitin Goyal, MD (University of Tennessee HSC)	No disclosure on file

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