Intracranial cavernous angiomas

Objective: To describe the clinical presentation, diagnosis, and management of patients presenting with intracranial cavernous angiomas (CAs) at a tertiary care hospital in Pakistan. Study Design: Case series. Place and Duration of Study: Section of Neurosurgery, The Aga Khan University Hospital (AKUH), Karachi, from January 1990 to September 2008. Methodology: A retrospective case note review of all patients diagnosed with intracranial CAs at AKUH during the study period. The studied variables included patient demographics, clinical presentation, family history of intracranial CAs or other space occupying lesions, modality of diagnosis, management, and outcome. Results were described as frequency percentages. Results: During the review period, 18 patients (11 males and 7 females) were diagnosed with intracranial CAs. The median age at diagnosis was 28.5 years. The most common location of malformations was cerebrum (n=13) followed by brain stem (n=3), and cerebellum (n=2). Nine patients had multiple lesions. Family history was present in 2 patients. Seizures and focal neurologic deficits were the main clinical manifestations. The detection rate was 93.8% with magnetic resonance imaging, but less with angiography and computerized tomography. Ten cases were treated surgically; 8 were managed conservatively. The outcome was satisfactory except for one patient, who died within 6 months of diagnosis. Surgery was performed for gross haemorrhage, rapidly increasing neurologic deficits, and intractable or long-standing seizures. Conclusion: Cavernomas tend to occur at younger age in females than males. This data raises a possibility of a higher frequency of multiple cavernomas in Pakistani patients. The main clinical manifestations are seizures and focal neurologic deficits. MRI is most sensitive and specific neuroradiologic modality for detecting this vascular malformation.