Synonyms:
a.k.a. Cavernous hemangioma a.k.a. Cavernous angioma a.k.a. cavernoma
Pathology:
Dilated thin walled veins, without intervening brain tissue, surrounding gliosis & hemosiderin, no elastin in the walls
Diagnosis:
MRI:
- TI, T2 & FLAIR: Heterogenous mass (blood at different ages) with high signal on TI, T2 & FLAIR, low signal rim (hemosiderin) on T2 & FLAIR
- DWI: normal
- Contrast: no enhancement or minimal enhancement especially if with associated developmental venous anomaly
- Usually in the brain, rarely occur in the spinal cord
- Giant if >6 cm
MRA: normal
Catheter angiography:
- Usually Normal
- Capillary blush may occur especially on repeated injection, also suggests a draining vein or venous malformation
- Mass effect if hemorrahge has occurred
CT:
- Round densities with Central Calcification with mild enhancement & without oedema or sulcal effacement.
- Usually negative
CTA: usually negative
Zabramski classification:
Type 1: subacute hemorrhage
Type 2: mixed signal with hemorrhage of various ages
Type 3: chronic hemorrhage
Type 4: punctate microhemorrhages
Genetic forms:
CCM1 gene chr. 3,7q, KRIT1 protein
CCM2 gene
CCM3 gene
Treatment:
- Antiepileptics if seizures occur
- Consider surgery if previously ruptured, and further rupture risk is estimated to be higher than surgical risk