Abstract
Intracranial cavernoma is a vascular malformation composed of thin-walled vascular vessels. Blood flow in these lesions is much lower than in AVMs and their hemorrhages are usually small. The presentation is often subacute with seizures or focal neurological deficit, which can be confused in pregnant women with pregnancy toxaemia especially if the malformation is bleeding. We report the case of a 35-year-old patient , 30 weeks pregnant , admitted for delivery who presented with acute intracranial hypertension syndrome with obnubilation of consciousness. Emergency brain CT showed a right fronto-parietal intracranial hematoma. MRI with angiographic sequences show a left parietal hematoma without visible arteriovenous malformation. The patient underwent emergency surgery to evacuate her intracranial hematoma, then the patient was transferred to a gynecological unit for emergency fetal extraction. Histo-pathological analysis of the removed fragments showed an intracranial cavernoma appearance. Urgent surgical evacuation is only necessary if the prognosis is vital.
Highlights
Cavernomas of the central nervous system are defined by the presence of capillary-type vascular malformations without interposition of nervous tissue
Very few cases of cavernoma in pregnancy have been reported in the literature and management is poorly codified
We report a case of cavernoma in a pregnant woman and review the literature
Summary
Cavernomas of the central nervous system are defined by the presence of capillary-type vascular malformations without interposition of nervous tissue. Very few cases of cavernoma in pregnancy have been reported in the literature and management is poorly codified. We report a case of cavernoma in a pregnant woman and review the literature. CASE REPORT A 35-year-old female patient, right-handed, 30 weeks pregnant, was admitted to the emergency room with consciousness problems. Clinical examination found a somnolent patient with 14/15 GSC and right hemiplegia. The cerebral CT scan (Fig. 1A) showed spontaneous hyperdensity of the left temporoparietooccipital junction with perilesional hypodensity. Brain MRI (Fig. 1) showed a hematoma of the left temporoparietooccipital junction with no clear image of arterio venous malformation. The patient was taken in charge by the obstetrical surgeons who opted for a cesarean section. The follow-up brain scan showing oedemato-hemorrhagic remodelling.
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