Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: Bleeding Cavernous Hemangioma?
Forum: The Neurology and Neurosurgery Forum
Topic Area: Neurosurgery - General
Posted by CCF Neuro[P] MD, RPS on January 21, 1999 at 12:04:24:
In Reply to: Bleeding Cavernous Hemangioma? posted by H. E. on January 21, 1999 at 02:59:06:



First, I would like to congratulate you on this excellent forum.
I am a 52 year old male. I frequently suffer from bouts of fatigue, lack of concentration and mild problems with short memory and speech (difficulty to find the right words). Eight months ago, I suffered a mild dizziness spell and started hearing ringing in the left ear. An M.R.I. showed a 1.5 cm cavernous hemangioma in the left frontal lobe. The ENT specialist, who ordered the MRI did not find anything wrong with my middle ear and referred me to a neurologist. I am still waiting to see him.

Since I had that diziness spell, I have had several strange things that happened when I am asleep. I feel that I am in my bed and in my bedroom but I feel as if something is holding me and preventing me from moving. Sometimes I feel like a surge of electricity runs all over my back and I can't move for a while. I feel that my eyes are opened but they are rolled up and I can see part of my room. I am not sure if these were bad dreams but it feels so real. I also think that I do not wake up right after it happens but sometimes later.

My questions are:
Is there any possible explanation for these episodes? Does the agioma have anything to do with them?
Can you tell from the MRI report whether the angioma has bled? The reprt says:
"The lesion is outside the increased signal intensity on the T1 weighted images with a vague peripheral rim of decreased signal intensity. On the the T2 weighted and proton density images the cetral reigon shows an increasing signal intensity while the peripheral rim shows a loss of signal intensity. The gradient sequence was obtained to assess for blood break down products. This MPGR sequence shows a profound loss of signal within the lesion indicating the presence of a hemosiderin."

Thanks for your help

Dear H.E.:

Sorry to hear about your cavernous angioma. For the report it sounds like your angioma has bled. This is not uncommon for these to bleed. These are small malformations of the blood vessels that have no brain tissue within them. Sometimes the abnormal vessels bleed. If the blood escapes, then it can irritate the brain and sometimes cause seizures or headaches. The events might be a seizure but it is difficult to call it that without examining you and seeing the MRI and doing a EEG. Frontal lobe seizures can be atypical of what we think of seizures to be. They seem to occur during the waking and going to sleep parts of sleep. I would think that your neurologist will want to do a work up for the possibility of seizure. If, and let me repeat if, this is a seizure event it is likely that you have had this angioma a long time and since you have only had 3-4 events, it is encouraging. Usually, most people seldom realize they have angiomas unless something abnormal leads to an investigation like you had. Let us know what happens.

Sincerely,

CCF Neuro[P] MD

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