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Bleeding Cavernous Hemangioma?

  : : : : 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
  : : Thank you, Dr. for the prompt response. I have been anxiously waiting to see a neurologist  since the lesion was discovered a few weeks ago.  Through this forum, I was able to know what  a cavernous angioma is and get very useful information. It is comforting to know that it is a good sign that angioma has not caused  major problems given the likelyhood of its long term presence.  I know that it is difficult for you to answer questions based on the limited info that I have but I hope that you will be able to shed some light on something that has been a mystery for several years.
  : : As part of investigating the cause of my fatigue, I was   subjected to a divided attention and reaction time study about 7 years ago. The results indicated that I did poorly, found it difficult to balance attention between the various sub-tests and that my performance resembled the performance level of some of the head injured subjects previously tested. I do not recall having any head injury and the Drs could not find any explanation for this.
  : : Is it possible that the presence of the angioma and/or an earlier bleeding from it be responsible for this head-injury like  performance?
  : : Once again, I really appreciate your help.
  : Dear H.E.:
  : I would doubt if the attention part of what you have been experiencing long term is the result of the angioma.  Likely this is due to something else.  Just before I forget, there are some forms of this entity that are inherited, as an autosomal dominant.  If you have children, you might want to keep this in the back of your memory and if any of them have neurological deficits then get an MRI.
  : Sincerely,
  : CCF Neuro[P] MD
  Dear Dr. [P]
  Thank you  and God bless you..
Dear H.E.
Thank you, you are the very first person who has had the large enough heart to thank me for giving an opinion about something on this server.  Most people I find think of medicine as their right and not a service that other people provide.  What we as providers forget is that there is only one great healer and we are not him.  
CCF Neuro[P] MD

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