Intracranial Cavernous Hemangioma and Seizures in a Newborn Infant

Abstract

A 3.28-kg male infant was delivered at 40 week's gestation by means of cesarean delivery for a non-reassuring CTG, after an uncomplicated pregnancy. After successful transition, he was transferred to the post-natal ward for routine newborn care. At 50 hours of age, the infant had a left-sided tonic-clonic seizure. With non-contrast axial computed tomography (Figure, A), high attenuation areas in the right frontal lobe and germinal matrix adjacent to the right lateral ventricle (arrows) were shown, consistent with an intracerebral haemorrhage. With axial T2-weighted magnetic resonance imaging (Figure, B), a low signal was shown in the right frontal lobe and adjacent to the right lateral ventricle (arrows) at the sites of the intra-parenchymal hemorrhage. A vascular channel connecting these 2 separate lesions (arrowhead) showed no communication with the main circulation. In conjunction with magnetic resonance angiography and MRV imaging (not shown), the appearances represent 2 separate cavernous hemangioma isolated from the intracranial circulation and complicated by a parenchymal hemorrhage. Cavernous hemangiomas of the central nervous system are benign vascular malformations that are best imaged with magnetic resonance imaging.1Ng B.H. Mulyadi E. Pereira J.K. Ghedia S. Pinner J. Mowat D. et al.Familial cerebral cavernous haemangioma diagnosed in an infant with a rapidly growing cerebral lesion.Australas Radiol. 2006; 50: 583-590Crossref PubMed Scopus (14) Google Scholar These vascular lesions of the brain are uncommon, rarely present in the first year of life, and represent only a small proportion of all central nervous system vascular anomalies.2Sakai N. Yamada H. Nishimura Y. Shirakami S. Futamura A. Andoh T. Intracranial cavernous angioma in the 1st year of life and a review of the literature.Childs Nerv Syst. 1992; 8: 49-52Crossref PubMed Scopus (24) Google Scholar Clinical manifestations most often associated with intracranial cavernous hemangiomas include: seizures, hemorrhagic syndrome, and mass lesion effect with hydrocephalus or focal neurological deficits. A congenital intracranial cavernous hemangioma is particularly rare and an unusual cause of neonatal seizures. Complete surgical resection yields an excellent outcome for large hemangiomas, but the optimum treatment for smaller lesions remains unclear. Spontaneous regression of extracranial cavernous hemangiomas during childhood is common, but the natural progression of intracranial cavernous hemangiomas is less well-described.3Prensky A.L. Gado M. Angiographic resolution of a neonatal intracranial cavernous hemangioma coincident with steroid therapy. Case report.J Neurosurg. 1973; 39: 99-103Crossref PubMed Scopus (5) Google Scholar This infant has been treated conservatively and remains seizure free with medication. Intracranial cavernous hemangiomas of infancyThe Journal of PediatricsVol. 157Issue 1PreviewTo the Editor: Full-Text PDF