title: rFVIIa--for acute rebleeding of a cerebral cavernous malformation.
abstract: Recurrent bleeding episodes of cavernomas especially in the brainstem can cause progressive neurological deficits. Therefore brainstem cavernomas are still a therapeutic dilemma and a treatment challenge for the neuro critical care community. We report a 39-year-old woman with spontaneous ataxia diplopia and vomiting, who has been treated for multiple intracerebral cavernomas during the last 10 years. A cerebral computed tomography (cCT) revealed a re-bleeding cavernoma in the left cerebral peduncle with consecutive obstructive hydrocephalus. As a result of the difficult anatomical location, no surgical approach was possible. As an off-label treatment, recombinant activated factor VII (rFVIIa) was administered to prevent possible further bleeding and especially further sequelae. The patient recovered well and no adverse events and especially no further bleeding of the cavernoma were observed. To our knowledge, this is the first report of the safe and successful use of rFVIIa to treat re-bleeding episodes in cavernomas. Further clinical studies are needed to specify the future potential of rFVIIa.
authors.affiliation: Department of Neurology, Neurological Intensive Care Unit, Medical University, Innsbruck, Austria. klaus.engelhardt@uibk.ac.at
authors.forename: K
authors.initials: K
authors.lastname: Engelhardt
authors.forename: C
authors.initials: C
authors.lastname: Brenneis
authors.forename: B
authors.initials: B
authors.lastname: Pfausler
authors.forename: R
authors.initials: R
authors.lastname: Beer
authors.forename: G
authors.initials: G
authors.lastname: Brössner
authors.forename: R
authors.initials: R
authors.lastname: Helbok
authors.forename: P
authors.initials: P
authors.lastname: Lackner
authors.forename: E
authors.initials: E
authors.lastname: Schmutzhard
mesh_terms: D000208:Acute Disease; D000328:Adult; D016543:Central Nervous System Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005167:Factor VII / Q000627:therapeutic use*; D015942:Factor VIIa; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D011859:Radiography; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa