title: Association between trauma and acute hemorrhage of cavernous malformations in children: report of 3 cases.
abstract: OBJECTIVE Cavernous hemangiomas are benign congenital vascular abnormalities. Intracerebral cavernous hemangiomas have an appreciable risk of spontaneous hemorrhage. Little is known as to whether head trauma increases the risk of bleeding for these lesions. In this study, the authors present a case series of 3 patients with posttraumatic nonspontaneous hemorrhage of intracerebral cavernous malformations (CMs). For the first time, to the authors' knowledge, they propose that trauma might constitute a risk factor for acute hemorrhage in intracerebral cavernomas. METHODS The authors reviewed the charts of all patients with a new diagnosis of intracerebral cavernoma at their pediatric hospital between 2010 and 2014. Patients with a history of head trauma prior to presentation were subsequently studied to identify features common to these posttraumatic, hemorrhage-prone lesions. RESULTS A history of head trauma was identified in 3 of 19 cases. These 3 patients presented with seizures and/or headaches and were found to have acute hemorrhage within a cavernous hemangioma. None of these patients had any history of abnormal neurological symptoms. All 3 abnormal vascular lesions had associated developmental venous anomalies (DVAs). The 3 patients underwent resection of their respective vascular abnormalities, and the diagnosis of cavernous hemangioma was confirmed with postsurgical tissue pathology. All 3 patients had complete resolution of symptoms following complete excision of their lesions. CONCLUSIONS Trauma may represent a risk factor for acute hemorrhage in patients with CMs. The presence of associated DVAs may represent a risk factor for posttraumatic hemorrhage of cavernomas. Excision should be considered in such cases, if feasible.
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;|Department of Neurosurgery, Women & Children's Hospital of Buffalo-Kaleida Health; and.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Fanous
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;|Department of Neurosurgery, Women & Children's Hospital of Buffalo-Kaleida Health; and.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Jowdy
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;|Department of Neurosurgery, Women & Children's Hospital of Buffalo-Kaleida Health; and.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Lipinski
authors.affiliation: Department of Pathology and Anatomical Sciences, Kaleida Health System; Buffalo, New York.
authors.forename: Lucia L
authors.initials: LL
authors.lastname: Balos
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;|Department of Neurosurgery, Women & Children's Hospital of Buffalo-Kaleida Health; and.
authors.forename: Veetai
authors.initials: V
authors.lastname: Li
mesh_terms: D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006257:Head / Q000000981:diagnostic imaging; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: CM = cavernous malformation; CTA = CT angiography; DVA = developmental venous anomaly; WCHOB = Women and Children's Hospital of Buffalo; acute hemorrhage; cavernous malformation; developmental venous anomaly; trauma; traumatic brain injury; vascular disorders