Cavernous angioma natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.

Cavernous angioma is usually a benign course since it is a low-flow and low-pressure lesion. Patients with cavernous angioma have variable signs and symptoms, with seizure as the most predominant symptom, followed by hemorrhage and focal neurologic deficit.

Once patients become symptomatic, 40-50% present with seizures, 20% present with focal neurologic deficits, and 10-25% present with intracerebral parenchymal hemorrhage.^[1]

• The risk of hemorrhage is not well established, but it is estimated to be 0.2-2% per lesion per year.
• This risk is increased in patients with established prior hemorrhage.
• The clinical consequences of hemorrhage vary such that location becomes important.
• Small hemorrhages in critical locations can have more severe effects, and thus, they are more likely to produce symptoms (e.g. brainstem involvement).
• Progressive neurologic deficits are more often associated with cavernous malformations in the infratentorial space and with lesions that demonstrate slow enlargement because of rebleeding episodes.

• The lesions do not usually produce life-threatening hemorrhages because most hemorrhages associated with the lesions are small and of low pressure. ^[1]
• Cavernous malformations can occur at any age, but they are most likely to become clinically apparent in patients aged 20-40 years.