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Neurology (Expert Forum)
Re: Cavernous Angioma - "Spells"
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Re: Cavernous Angioma - "Spells"
by Ane-Racer, Jan 01, 1995 12:00AM
Posted By Anne Racer on May 10, 1999 at 09:32:53
I am a 48 year old female with a history of atypical migraines who was diagnosed with a 1cm cavernoma in the right cerebellar hemisphere 9/9/93. The incident that led to its discovery was a stroke-like episode including confusion, loss of short-term memory, weakness on the left side, followed by ringing in first the left then both ears. Slight weakness on the left side and ringing in the ears continues. Some neurologist identify this episode as having been a stroke, others say no.
Since this initial episode I have experienced "spells" i.e. periods of weakness and fatigue, tingling on the left side, loss of speech, then what doctors describe as myclonic-type jerking of the left side. Personal observations indicate visual stimulus (strobe-type light/color, excessive visual movement, etc.) as the major provocation of the "spells". These "spells" have been captured on an EEG but do not show epileptic activity; EEG's have been classified as normal. Neurologists therefore are not classifying the "spells" as seizures and are not associating them with the cavernoma.
Recently, the "spells" have increased in frequency, intensity, and duration (as many as 8 episodes in one day). Klonopin .25 mg 3-4 times a day has been prescribed and does control, but does not eliminate the "spells". The drug side effects are lack of affect, drowsiness, and an inability to perform in my position as an architect and director of a department.
I have had 5 MRI's and 3 EEG's. Results are summarized below:
September 10, 1993: MRI
"There is a foci of low signal on the T2 images and the GRASS images in the right cerebellar hemisphere just adjacent to the brachium pontus. GRASS imaging shows no other foci of low signal intensity. Most likely explanation for this finding is a small cavernoma which has previously hemorrhaged (remotely) with hemosiderin deposition in the adjacent brain. No evidence of stroke, MS, or other abnormalities seen in the remainder of the brain."
September 30, 1993: MRI
Basically same results, plus, "The appearance is consistent with hemosiderin. There is a punctate central high signal on all sequences of uncertain significance possibly representing met hemoglobin. MRA through this area show no abnormality and there is nor evidence that this represents AVM."
December 10, 1993: MRI
Basically same results, plus, "This finding demonstrates blooming on the gradient echo images suggesting the presence of hemosiderin. A small venous angioma may be present."
April 17, 1996: MRI
Basically same results, plus, "1 cm diameter rounded focus of marked hypointenisty in the right cerebellar hemisphere at the junction of the middle cerebellar peduncle, on proton density. The previously mentioned small adjacent vessel is not appreciated on the current study."
April 22, 1999: MRI
Do not have results, but doctors say scan shows cavernoma as unchanged.
After consultations with multiple neurologists I still have no answers and no direction other than to first, medicate the symptoms with klonopin, then seek psychological help. With or without medication, I am unable to work; my lifestyle has been significantly impacted. Questions: Can the myclonic jerking be related to the cavernoma even though my EEG's are normal? Are there classifications of "seizures" other than those associated with epilepsy, or which would include the "spells" I describe? Is there someone who can help us further investigate and possibly resolve the problem?
Thank you for your service and time which gives hope to people like me who have reached a point of desperation.
Anne Racer
I am a 48 year old female with a history of atypical migraines who was diagnosed with a 1cm cavernoma in the right cerebellar hemisphere 9/9/93. The incident that led to its discovery was a stroke-like episode including confusion, loss of short-term memory, weakness on the left side, followed by ringing in first the left then both ears. Slight weakness on the left side and ringing in the ears continues. Some neurologist identify this episode as having been a stroke, others say no.
Since this initial episode I have experienced "spells" i.e. periods of weakness and fatigue, tingling on the left side, loss of speech, then what doctors describe as myclonic-type jerking of the left side. Personal observations indicate visual stimulus (strobe-type light/color, excessive visual movement, etc.) as the major provocation of the "spells". These "spells" have been captured on an EEG but do not show epileptic activity; EEG's have been classified as normal. Neurologists therefore are not classifying the "spells" as seizures and are not associating them with the cavernoma.
Recently, the "spells" have increased in frequency, intensity, and duration (as many as 8 episodes in one day). Klonopin .25 mg 3-4 times a day has been prescribed and does control, but does not eliminate the "spells". The drug side effects are lack of affect, drowsiness, and an inability to perform in my position as an architect and director of a department.
I have had 5 MRI's and 3 EEG's. Results are summarized below:
September 10, 1993: MRI
"There is a foci of low signal on the T2 images and the GRASS images in the right cerebellar hemisphere just adjacent to the brachium pontus. GRASS imaging shows no other foci of low signal intensity. Most likely explanation for this finding is a small cavernoma which has previously hemorrhaged (remotely) with hemosiderin deposition in the adjacent brain. No evidence of stroke, MS, or other abnormalities seen in the remainder of the brain."
September 30, 1993: MRI
Basically same results, plus, "The appearance is consistent with hemosiderin. There is a punctate central high signal on all sequences of uncertain significance possibly representing met hemoglobin. MRA through this area show no abnormality and there is nor evidence that this represents AVM."
December 10, 1993: MRI
Basically same results, plus, "This finding demonstrates blooming on the gradient echo images suggesting the presence of hemosiderin. A small venous angioma may be present."
April 17, 1996: MRI
Basically same results, plus, "1 cm diameter rounded focus of marked hypointenisty in the right cerebellar hemisphere at the junction of the middle cerebellar peduncle, on proton density. The previously mentioned small adjacent vessel is not appreciated on the current study."
April 22, 1999: MRI
Do not have results, but doctors say scan shows cavernoma as unchanged.
After consultations with multiple neurologists I still have no answers and no direction other than to first, medicate the symptoms with klonopin, then seek psychological help. With or without medication, I am unable to work; my lifestyle has been significantly impacted. Questions: Can the myclonic jerking be related to the cavernoma even though my EEG's are normal? Are there classifications of "seizures" other than those associated with epilepsy, or which would include the "spells" I describe? Is there someone who can help us further investigate and possibly resolve the problem?
Thank you for your service and time which gives hope to people like me who have reached a point of desperation.
Anne Racer
Dear Ann:
Sorry to hear about your events. It sounds like your cavernous angioma is having some irritation that is inducing your "spells". We know that hemosiderin is an irritant and can induce seizure-like events. Although the EEG hasn't recorded any abnormality, does not rule out seizure-or seizure-like events. It may be that the EEG was not done during one of your spells. Klonepin is usually a good medication for myoclonic seizures, but there are also others such as lamictal.
I think I would get a second opinion from an epileptologist. Take all the information, MRI scans, eegs and see what this second opinion has to say. I hope that this can be resolved. It is important to find out if your myoclonic activity is actually seizures or just paroxysomal (e.g. not related to abnormal brain activity).
Sincerely,
CCF Neuro[P] MD
Follow Ups:
Cavernous Angioma - "Spells" Kelly 5/12/1999
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Re: Cavernous Angioma - "Spells" CCF Neuro[P] MD, RPS 5/12/1999
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