Our fifteen year old daughter has had recent episodes of falling and a recent MRI w/o contrast was done. The neurosurgeons read the scan and are indicating a cavernous angioma with multiple small hemorrhage, it presently measures just over l cm. Their suggestion is to wait a month and have an MRA. Unsure of how to procede or what to expect. Should we be more aggressive or just wait this out? What symptoms should we be looking for? She is a defensive soccer player, should we be limiting her activity? What is the surgical procedure and what is the recovery time? We are a bit frantic but trying to stay calm...Thank you Teri.
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine and obtain a history and review the imaging I can not discuss the exact implications of the imaging findings. However I will try to provide you with some useful information.
A cavernous angioma (also known as cerebral cavernous malformation, CCM) is a vascular malformation, consisting of a small collection of endothelial cells (blood vessel cells). These are thought to be present at birth. They intermittently may have small microbleeds, enlarging slowly over time. They may be discovered incidentally, or may cause symptoms such as seizures or headaches depending on their size and location. When a significant amount of sudden bleeding it to the cavernous malformation occurs, abrupt stroke symptoms may occur. When the cavernous malformation is located in a critical area of the brain (such as the brainstem) even a small hemorrhage can be significant.
The frequency of clinically relevant hemorrhages into a CCM is around 1-3% per year. Some people live their entire lives without symptoms, others suffer from neurologic symptoms, disability, or even death. The exact clinical course depends on the location of the CCM, whether or not more than one is present, and other factors.
In general, CCMs are not operated on or otherwise intervened on unless they are leading to epilepsy not controllable with medications, they are repeatedly bleeding in critical areas, or they are enlarging at a concerning rate. Typically, with CCMs, periodic MRI every 1-2 years is conducted to observe the CCM.
While in general exercise and other day-to-day activities do not need to be limited, particular avoidance of head trauma, very vigorous activities, avoidance of blood thinners, and monitoring of blood pressure (usually more in adults) are generally recommended.
It is important for you to understand the exact location and size of the hemorrhage and whether or not your daughter's symptoms (the falling) is thought to be due to the CCM. If there is concern that the CCM is leading to episodes of falling, and if there is transient alteration of awareness, seizures may need to be considered and evaluated for. Discussion of the management options with your daughter's physicians is recommended.
Here is a very useful website for more information: www.angiomaalliance.org
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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