title: Propranolol Treatment of Cavernous Malformations with Symptomatic Hemorrhage.
abstract: BACKGROUND
  Cerebral cavernous malformations are more common than generally thought, affecting approximately 1 in every 250 adults. Most of these lesions are asymptomatic or have a relatively benign course, but a small minority behave aggressively and present with recurrent episodes of symptomatic hemorrhage. A safe and effective medical treatment option for the management of this latter group would be useful. Propranolol has recently been shown to be effective in the treatment of infantile hemangioma, a close pathologic counterpart of cavernous malformations. These results suggest a potential role for propranolol treatment in the management of patients with symptomatic cavernous malformations.
  
  
  METHODS
  Low-dose propranolol (20 mg, three times daily) was used to treat 2 adult female patients in their mid- to late fifties, both of whom had symptomatic cavernous malformations and a history of repeated hemorrhage. Serial magnetic resonance imaging studies after the initiation of propranolol demonstrated regression of the lesions and no evidence of recurrent hemorrhage.
  
  
  CONCLUSIONS
  Propranolol may offer a safe and effective treatment for patients who have cavernous malformations with symptomatic hemorrhage. Additional studies are needed to confirm these findings.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Zabramski
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: M Yashar S
authors.initials: MYS
authors.lastname: Kalani
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Aristotelis S
authors.initials: AS
authors.lastname: Filippidis
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D011433:Propranolol / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol
keywords: Beta-blockers; Cavernous malformations; Cerebral cavernous malformations; Hemorrhage; Propranolol; Symptomatic