Cavernoma

An Overview

A cavernoma is a cluster of abnormal blood vessels, usually found in the brain and spinal cord. They’re sometimes known as cavernous angiomas, cavernous hemangiomas, or cerebral cavernous malformation (CCM). Approximately one in 200 people have a cavernoma. Many are present at birth, and some develop later in life, usually along with other endovascular abnormalities such as a venous malformation. Most do not have a family history of cavernomas. If you have more than one, though, we may suspect a genetic component. If you have the inherited form of cavernomas, each of your children has a 50 percent chance of inheriting the condition. We are researching narrowing down the precise mutation that causes the condition. A typical cavernoma looks like a raspberry. It’s filled with blood that flows slowly through vessels that are like “caverns”. A cavernoma can vary in size from a few millimetres to several centimetres across.

Cavernomas are dynamic structures, changing in size and number over time and can range in size from a few millimeters to several centimeters. The majority of cavernomas that are diagnosed occur in individuals with only a single lesion and no family history of the disease (these cases are termed “sporadic” meaning they are not caused by an inherited genetic mutation). Individuals with the familial (genetic) form of cavernomas are likely to have multiple lesions and may be more likely to experience symptoms associated with the disorder.

Why do I have blood coming out of my cavernoma?

The cells lining a cavernoma are often thinner than those that line normal blood vessels, which means they’re prone to leaking blood. In most cases, bleeding is small – usually around half a teaspoonful of blood – and may not cause other symptoms.

Symptoms of cavernoma

We usually only diagnose a cavernoma after you have had a seizure, a loss of function, or a surprise finding when we perform a magnetic resonance imaging scan for another reason. Cavernomas may have no symptoms but about one in three people with cavernous angiomas eventually develop symptoms, often between ages 20 and 40.
A cavernoma often does not cause symptoms, but when symptoms do occur they can include:
• bleeding (haemorrhage)
• fits (seizures)
• headaches
• neurological problems, such as dizziness, slurred speech(dysarthria), double vision, balance problems and tremor
• weakness, numbness, tiredness, memory problems and difficulty concentrating
• a type of stroke called a haemorrhagic stroke
The severity and duration of symptoms can vary depending on the type of cavernoma and where it’s located.
Problems can occur if the cavernoma bleeds or presses on certain areas of the brain.
The cells lining a cavernoma are often thinner than those that line normal blood vessels, which means they’re prone to leaking blood. In most cases, bleeding is small – usually around half a teaspoonful of blood – and may not cause other symptoms.

Causes of cavernoma

Most CCMs occur as a single formation, without an apparent cause and without any family history.
However, roughly 20 percent of affected people have a familial (inherited) form of the disorder. In many cases, such people can identify similarly affected family members, most often with multiple malformations. A diagnosis of the inherited form can be confirmed by genetic testing. Depending on why the condition is suspected, doctors may order tests specifically to confirm CCMs, or to identify or rule out other related conditions. Brain imaging is also called for as soon as possible after the emergence of any new symptoms, to reveal either hemorrhage or the emergence of any new malformations.

Diagnosis

• Magnetic resonance imaging (MRI). In this test, a detailed picture is made of your brain or spine. The blood vessels in the brain may be imaged as well. Sometimes a doctor may inject a contrast dye into a vein in your arm to look at the brain tissue in a slightly different way, or to better look at the blood vessels in the brain (magnetic resonance angiography or magnetic resonance venography).

• Genetic testing. If you have a family history of the condition, genetic counseling and tests are helpful to identify changes associated with CCMs in genes or chromosomes.

Treatment

While a new diagnosis of brain cavernoma can produce natural anxious responses in many patients, the most important thing to remember is that you are not alone — cavernomas can occur in as many as 1 out of every 200 people – and our team of experts is here to help you understand your condition and determine an optimal, personalized treatment plan for your needs.
• Bleeding: We consider the frequency and amount of bleeding. Some cavernous angiomas bleed slowly enough that the body can re-absorb the blood. Others bleed more profusely and can put dangerous pressure on the surrounding brain tissue and/or cause an obvious hemorrhage. If your cavernous angioma has bled once, it is likely to bleed again, generally within two years of the first bleed.
• Number of cavernomas: The more cavernomas you have, the greater the chance of hemorrhage.
• Location: Some locations are more dangerous than others. If you have a cavernoma on your brain stem (where the brain connects to the spinal cord), in the cerebral cortex (the outer layer of the brain responsible for speech, motor, and visual abilities), or along the spinal cord, surgery is riskier than if the cavernoma is elsewhere. On the other hand, cavernomas in these areas can cause more damage when they do bleed than cavernomas located elsewhere. We weigh the risk versus benefit carefully when deciding on treatment plan.
• Presence of other endovascular abnormalities: Up to 40 percent of cavernomas occur near venous malformations, which can make surgical treatment more difficult.
Depending on thorough assessment of the above factors, treatment plans include:
• Watching and waiting: We observe for changes, recent hemorrhage, or worsening symptoms.
• Medications: We cannot directly treat the cavernomas with medicine, but we can help with symptoms such as seizures and headaches.
• Surgery: This is the only cure for cavernomas. We typically perform surgery on cavernous angiomas with a recent hemorrhage and those that are growing or causing seizures.

Hope this Symptoms and cure article will be helpful to all. Do not forget to share your valuable suggestions if any.

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