Natural history of the cavernous angioma

TLDR

The incidence and natural history of cavernous angioma have been unclear because of diagnostic challenges, but MR imaging has improved detection and monitoring. The study identified 76 presumed cavernous angiomas in 66 patients from 14,035 MR scans at Cleveland Clinic (1984‑89), followed 86 % of cases for an average of 26 months (143 lesion‑years), and confirmed all 14 surgically resected lesions histologically. Seizure, focal neurological deficit, and headache were the most common presentations; although most lesions showed occult bleeding on MR, overt hemorrhage occurred in only seven of 57 symptomatic patients (annual rate 0.7%) and one during follow‑up, with females at higher risk, providing data to guide treatment decisions.

Abstract

✓ The incidence and natural history of the cavernous angioma have remained unclear in part because of the difficulty of diagnosing and following this lesion prior to surgical excision. The introduction of magnetic resonance (MR) imaging has improved the sensitivity and specificity of diagnosing and following this vascular malformation. Seventy-six lesions with an MR appearance typical of a presumed cavernous angioma were discovered in 66 patients among 14,035 consecutive MR images performed at the Cleveland Clinic between 1984 and 1989. Follow-up studies in 86% of the cases over a mean period of 26 months provided 143 lesion-years of clinical survey of this condition. The most frequent presenting features were seizure, focal neurological deficit, and headache. While most lesions exhibited evidence of occult bleeding on MR imaging, there was overt hemorrhage in seven of the 57 symptomatic patients and only one overt hemorrhage occurred during the follow-up interval. The annualized bleeding rate was 0.7%. Analysis of the hemorrhage group revealed a significantly greater risk of overt hemorrhage in females. Pathological confirmation of cavernous angioma was obtained in all 14 surgical cases. This information assists in rational therapeutic planning and prognosis in patients with MR images showing lesions suggestive of cavernous angioma.