Irsyad Muhammad Ari, Fitra Fitra, Sanjaya Firman Adi, Suroto Nur Setiawan, Al Fauzi Asra
Universitas Sumatera Utara Hospital, Medan, Indonesia; Department of Neurosurgery, H. Adam Malik General Hospital, Medan, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
Int J Surg Case Rep. 2023 Jun;107:108332. doi: 10.1016/j.ijscr.2023.108332. Epub 2023 May 17.
Cavernous malformations are congenital or acquired vascular abnormalities. They are uncommon entities with an incidence of 0.5 % of the general population and usually are unnoticed until a hemorrhagic event occurs. Cerebellar cavernomas (CCMs) account for 1.2 to 11.8 % of all intracranial cases and 9.3 to 52.9 % of all infratentorial cases. Cavernomas can be concurrently seen with developmental venous anomalies (DVAs) in 20 % (range 20 %-40 %) of cases, in which case they are known as mixed vascular malformations.
We report a case of a healthy young adult who presented with acute onset of headache, with characteristics of chronic headache that gets progressively worse. The patient complains of frequent dizziness when sitting and standing for a long time. Complaints have been felt for two years and have worsened for the past two weeks. Additional complaints are dizziness and nausea with intermittent episodes of vomiting for four days. Magnetic resonance imaging (MRI) revealed an underlying cavernoma that had bled and a coexisting DVA. The patient was discharged home with no deficits. Outpatient follow-up two months later showed no symptoms or neurologic deficits.
Cavernous malformations are congenital or acquired vascular anomalies that occur in approximately 0.5 % of the general population. Our patient likely had dizziness due to localization of the bleeding of the cavernoma on the left side of the cerebellum. In our patient, brain imaging revealed numerous abnormal blood vessels radiating from the cerebellar lesion, a highly suggestive of DVAs associated with cavernoma.
A cavernous malformation is an uncommon entity that might coexist with deep venous anomalies, making management more challenging.
海绵状血管畸形是先天性或后天性血管异常。它们是罕见的病症，在普通人群中的发病率为0.5%，通常在出血事件发生之前未被发现。小脑海绵状血管瘤（CCM）占所有颅内病例的1.2%至11.8%，占所有幕下病例的9.3%至52.9%。在20%（范围为20% - 40%）的病例中，海绵状血管瘤可与发育性静脉异常（DVA）同时出现，在这种情况下它们被称为混合性血管畸形。
我们报告一例健康年轻成年人，其急性起病，头痛具有慢性头痛且逐渐加重的特点。患者主诉长时间坐立和站立时频繁头晕。这些症状已持续两年，在过去两周有所加重。另外的症状是头晕、恶心，伴有间歇性呕吐四天。磁共振成像（MRI）显示存在一个已出血的海绵状血管瘤以及并存的DVA。患者出院时无功能缺损。两个月后的门诊随访显示无症状或神经功能缺损。
海绵状血管畸形是先天性或后天性血管异常，在普通人群中的发生率约为0.5%。我们的患者可能因小脑左侧海绵状血管瘤出血的定位而出现头晕。在我们的患者中,脑部成像显示从小脑病变处放射出许多异常血管，这高度提示与海绵状血管瘤相关的DVA。
海绵状血管畸形是一种罕见的病症，可能与深部静脉异常共存，这使得治疗更具挑战性。
