Cavernous angioma in the medulla oblongata: case report

Cavernous angiomas are vascular malformations that occur throughout the central nervous system. Approximately 25% of cavernous angiomas are located in the brainstem. These lesions are more likely to present with an initial hemorrhage and are more likely to rebleed. Case report: A 29-year-old female was admitted to Riga East Clinical University Hospital due to severe headache at the back of the head and numbness on the right side of the body. In emergency unit computed tomography (CT) scan of brain, CT angiography were performed, that showed spontaneous intracerebral hemorrhage in medulla oblongata. Patient was hospitalized to Stroke unit. Few days after hospitalization her condition worsened, patient developed bulbar palsy and right sided hemiparesis. Head magnetic resonance imaging (MRI) showed cavernous angioma localised in medulla oblongata. Patient was discharged from the hospital and continued therapy in multiple rehabilitation centres, her condition improved. After seventeen months due to progressive headaches and repeated numbness on the right side of the body another head MRI was performed. The test showed increased volume subacute bilateral ponto-medullary hemorrhage. Our neurologists communicated with neurosurgeons from Esene University Hospital in Germany, patient had indications for neurosurgical treatment. Extirpation of the medullary cavernoma in semi-sitting position was performed and patient had no complications after surgery. Her neurological status significantly improved and patient was discharged from hospital with recommendations to continue further rehabilitation in Latvia.Keywords: Cavernous angioma, Intracerebral hemorrhage, Extirpation of a brainstem cavernoma. Brainstem cavernous angiomas can manifest with severe neurological symptoms and even can be a life-threatening condition. Clinically manifested cavernous angiomas due to the risk of repeated hemorrhage and severe complications need surgical intervention. This case report presents a 29-year-old woman with repeated intracerebral hemorrhage due to medullary cavernous angioma, that was successfully managed by surgical extirpation of the cavernoma.