DUAL MANIFESTATION OF INTRACRANIAL AND SPINAL CORD CAVERNOMAS

Abstract

Introduction Cerebral and spinal cord cavernomas are vascular anomalies of the nervous system characterized by dilated vessels lined with a single layer of endothelium. They exhibit minimal blood flow and can occur in both the brain and spinal cord. They affect approximately 0.5% of the population and constitute 15% of cerebral vascular malformations. While spinal cavernomas are less common, they can cause significant morbidity due to the risk of hemorrhage and resulting neurological deficits. Surgical removal to completely eliminate the vascular abnormality is the preferred treatment. Material and Methods We present the case of a 66-year-old female patient who presented to our clinic with headache, dizziness, and left-sided hemiparesis, predominantly affecting the lower limb. Cerebral MRI revealed an intracranial mass in the left parietal lobe with signs of acute bleeding. Due to clinical symptom discrepancies and imaging findings, cervical MRI was performed, revealing an intramedullary tumor formation adjacent to the C4-C5 vertebral bodies. The patient underwent two surgeries, achieving total ablation of the lesions. Results Post-operative CT confirmed complete ablation of the cavernomas. No neurological deficits were reported after removal of the parietal cavernoma. One month after the first surgical intervention, the patient underwent a second surgery to excise the cervical tumor. Postoperatively, the patient experienced numbness in the left hand, which improved in the first week postoperatively. Conclusions The prevalence of associated intracranial cavernous malformations (CMs) in patients with spinal cord CMs was found to be 5 to 12% and typically observed in patients with the familial form of the condition. The coexistence of intracranial and spinal cord CMs is more likely to lead to aggressive disease progression. Therefore, it is imperative that both lesions are surgically removed within 30 days of each other. Managing cavernomas remains a complex clinical decision, often balancing intervention risks against potential neurological morbidity.

Keywords

• spinal cavernomas
• intracranial cavernomas
• cervical cavernomas
• total ablation
• familial form cavernomas